The long-term impact of COVID-19 on nursing: An e-panel discussion from the International Network for Child and Family Centred Care.

AIM: To explore the International Network for Child and Family Centred Care (INCFCC) members' experiences and views on the long-term impact of COVID-19 on the nursing workforce. BACKGROUND: On the 11 March 2020, the World Health Organization declared COVID-19 a global pandemic. While some countries adopted a herd immunity approach, others imposed stricter measures to reduce the transmission of the virus. Hospitals in some countries faced an avalanche of extremely sick admissions, whereas others experienced an early surge in cases or were able to control the spread. DESIGN: Discursive paper. METHODS: A web-based survey was e-mailed to 63 INCFCC members from 28 March to 30 April 2022, as an invitation to share their experience concerning the long-term impact of COVID-19 on their role as a nurse educator, clinician or researcher. RESULTS: Sixteen members responded, and the responses were grouped under the themes stress and anxiety, safe staffing and pay, doing things differently, impact on research, impact on teaching and learning, impact on clinical practice, nursing made visible and lessons for the future. CONCLUSION: The INCFCC members provided their views and highlighted the impact on their role in nursing education, administration, research and/or practice. This discussion of international perspectives on the similarities and differences imposed by COVID-19 found that the impact was wide-ranging and prolonged. The overarching theme revealed the resilience of the participating members in the face of COVID-19. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of all areas of nursing, be it in academia or in clinical practice, to work together to learn from the present and to plan for the future. Future work should focus on supporting organizational and personal resiliency and effective interventions to support the nursing workforce both during a disaster and in the recovery phase. Nursing workforce resilience in the face of COVID-19.

Access to health care perceived by parents caring for their child at home supported by eHealth-a directed approach introducing aperture.

BACKGROUND: In recent years a variety of eHealth solutions has been introduced to enhance efficiency and to empower patients, leading to a more accessible and equitable health care system. Within pediatric care eHealth has been advocated to reduce emergency and hospital outpatient visits, with many parents preferring eHealth to physical visits following the transition from hospital to home. Still, not many studies have focused on access from the parental perspective. Therefore, the aim of the study was to analyze access to health care as perceived by parents when caring for their child at home, with conventional care supported by eHealth following pediatric surgery or preterm birth. METHODS: Twenty-five parents who went home with their child following hospitalization and received conventional care supported by eHealth (a tablet) were interviewed in this qualitative study. Directed content analysis was used, guided by a framework for dimensions of access previously described as: approachability, acceptability, affordability, appropriateness, and availability. RESULTS: All dimensions of access were present in the material with the dimensions of approachability, appropriateness and acceptability most frequently emphasized. The dimensions highlighted a strong acceptance of eHealth, which was perceived by the parents as beneficial, particularly access to communication with health care personnel familiar to them. The chat function of the tablet was often mentioned as positive. A new dimension was also identified: "aperture." It is defined by the pathways by which communication is transmitted in cyberspace, and these pathways are not easily visualized for parents submitting information, therefore generating concerns. CONCLUSIONS: Parents generally experienced good access to the eHealth-supported health care. Describing access through its dimensions complemented previous descriptions of eHealth in pediatric care and gave new insights. As such, the new dimension of "aperture", the indeterminate opening of pathways of communication reflecting the uncertainty of not comprehending cyberspace, could be further evaluated. The dimensional framework of access is recommended when evaluating eHealth in the future. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04150120.

Sociodemographic and health status predictors of parental role strain: A general population study.

Aims: Numerous studies indicate that stressors associated with parenthood can adversely affect parental well-being and children's psychosocial development. The aim of the study was to analyze sociodemographic differences in parental role strain in the general parental population. Methods: The study is based on a national postal survey of a random sample of 605 Icelandic mothers and fathers of children under 18. Results: Parental role strain was related to young parental age at first birth, female gender, non-married status, age of youngest child, age range of children, number of children in the household, and the parent's own chronic illness. Furthermore, chronic illness or disability of a child was markedly related to higher parental role strain, although the relationship was partly reduced with parental employment. Conclusions: Parental role strain is unevenly distributed in the parental population and varies by sociodemographic and health statuses of parents and children. Understanding and addressing parental role strain could improve parental mental health and help create a family environment that enhances the psychosocial development of children.

A systematic integrative review of parents' experience and perception of sleep when they stay overnight in the hospital together with their sick children.

AIMS AND OBJECTIVES: To elucidate knowledge available on parents' experience and perception of sleep when they stay overnight in hospital together with their sick children. BACKGROUND: In Nordic countries, children are entitled to have at least one parent with them during hospitalisation. Parents' sleep, when accommodated at the hospital during the child's admission, may be a challenge. DESIGN: A systematic literature search was conducted in EMBASE, MEDLINE and PsycINFO; period is restricted from 1 January 2007 to 1 April 2019. Studies included were those in which parents were accommodated in hospital with their child, 0-18 years of age, for at least one night. Original peer-reviewed scientific research papers conducting qualitative, quantitative or mixed designs were included. Systematic reviews were not included. This systematic integrative review was registered in PROSPERO and performed according to the PRISMA guidelines. All authors participated in study selection, data extraction and quality assessment of the literature. RESULTS: Fifteen studies were included, and they varied in terms of origin, aims, design, methods used and sample size. Three overall main themes appeared: sleep quality, factors affecting sleep and consequences of sleep loss. Combined psychological factors were found to affect parents' sleep, as well as isolated psychological factors, for example, stress, anxiety, worries and difficult thoughts. Environmental and social factors were also identified, for example, privacy and caring for family. CONCLUSION: Study of this subject is still in its exploratory phase. There is a need for the development of theory of substance in the clarification of the meaning of sleep among parents during difficult times such as children's hospitalisation. RELEVANCE TO CLINICAL PRACTICE: Understanding risk factors associated with sleep and sleep deprivation in parents staying overnight in the hospital with their sick child is important, since lack of sleep may lead to serious stress-related outcomes for the parents.

Bullying, pain and analgesic use in school-age children.

AIM: The aim of this study was to examine whether the self-reported use of analgesics is associated with being a victim of bullying. METHODS: This cross-sectional, school-based survey included all students in grades 6 (11 years old), 8 (13 years old) and 10 (15 years old) in Iceland (response rate: 84%; n = 11 018). The students filled out an anonymous standardised questionnaire: the Icelandic Contribution to the International Health Behavior in School-Aged Children (HBSC) Study. RESULTS: Being bullied was associated with increased use of analgesics even after controlling for self-reported pain. CONCLUSION: Bullying occurs in all schools, and its effects on health are pervasive. Interventions aimed at reducing bullying and promoting health in schools are important and may reduce the use of analgesics in adolescents.

Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R).

BACKGROUND: Preterm infants are especially vulnerable to pain. The intensive treatment often necessary for their survival unfortunately includes many painful interventions and procedures. Untreated pain can lead to both short- and long-term negative effects. The challenge of accurately detecting pain has been cited as a major reason for lack of pain management in these non-verbal patients. The Premature Infant Pain Profile (PIPP) is one of the most extensively validated measures for assessing procedural pain in premature infants. A revised version, PIPP-R, was recently published and is reported to be more user-friendly and precise than the original version. The aims of the study were to develop translated versions of the PIPP-R in Finnish, Icelandic, Norwegian, and Swedish languages, and to establish their content validity through a cultural adaptation process using cognitive interviews. METHODS: PIPP-R was translated using the recommendations from the International Society for Pharmacoeconomics and Outcomes Research and enhanced with cognitive interviews. The respondent nurse was given a copy of the translated, national version of the measure and used this together with a text describing the infant in the film to assess the pain of an infant in a short film. During the assessment the nurse was asked to verbalize her thought process (thinking aloud) and upon completion the interviewer administered probing questions (verbal probing) from a structured interview guide. The interviews were recorded, transcribed, and analyzed using a structured matrix approach. RESULTS: The systematic approach resulted in translated and culturally adapted versions of PIPP-R in the Finnish, Icelandic, Norwegian and Swedish languages. During the cultural adaptation process several problems were discovered regarding how the respondent understood and utilized the measure. The problems were either measure problems or other problems. Measure problems were solved by a change in the translated versions of the measure, while for other problems different solutions such as education or training were suggested. CONCLUSIONS: This study have resulted in translations of the PIPP-R that have content validity, high degree of clinical utility and displayed beginning equivalence with each other and the original version of the measure.

Bullying in School-aged Children in Iceland: A Cross-sectional Study.

PURPOSE: We describe the frequency and variations in bullying among a representative national sample of school-age children and examine whether sociodemographic characteristics are associated with bullying. DESIGN AND METHODS: This study is based on a cross-sectional school-based survey-the Icelandic contribution to the international research network Health Behaviour in School-aged Children (HBSC). The study population included all students in Iceland in grades 6, 8 and 10 (mean ages: 11, 13 and 15years, respectively) (participation rate: 84%; n=11,018). The students completed an anonymous standardized questionnaire administered in the classroom. RESULTS: The self-reported frequency of being victimized by bullying at least 2-3 times every month was 5.5%. A younger age, speaking a foreign language at home, not living with one's parents, and living in a rural area, were all associated with higher frequencies of being bullied. CONCLUSIONS: Despite efforts to reduce bullying in school, experiences of being victimized through bullying are still too common among Icelandic school-age children. Stakeholders and school health administrators should consider sociodemographic antecedents when planning interventions to reduce bullying at school.

Venous oxygen saturation is reduced and variable in central retinal vein occlusion.

PURPOSE: To estimate the presence and variability of retinal hypoxia in patients with central retinal vein occlusion (CRVO). METHOD: Hemoglobin oxygen saturation was measured in retinal vessels of both eyes in 14 patients with unilateral CRVO. The noninvasive spectrophotometric retinal oximeter is based on a fundus camera and simultaneously captures two images at 570 nm and 600 nm wavelengths. Five of the patients were followed with repeated retinal oximetry images over time. RESULTS: The mean oxygen saturation in retinal venules was 31 % ±12 % in CRVO eyes and 52 % ±11 % in unaffected fellow eyes (mean ±SD, n = 14, p < 0.0001). The arteriovenous difference was 63 % ±11 % in eyes with CRVO and 43 % ±7 % in fellow eyes (p < 0.0001). The variability of retinal venous oxygen saturation was substantial within and between eyes affected by CRVO. Venular oxygen saturation improved with treatment and over time in all five patients that were followed. CONCLUSION: CRVO eyes are hypoxic compared to fellow eyes and arteriovenous difference in hemoglobin oxygen saturation is increased. This is consistent with tissue hypoxia resulting from reduced blood flow. Further studies are needed to understand the correlation between hypoxia, severity of disease and prognosis.

A comparative analysis of movement and physical activity in early childhood teacher education policy in five Nordic countries.

Introduction: The aim of this study is to investigate the integration of movement and physical activity (MoPA) within Early Childhood Teacher Education (ECTE) policies across Denmark, Finland, Iceland, Norway, and Sweden. This knowledge can inform the development of ECTE policies and practices that promote MoPA in Early Childhood Education and Care (ECEC) in Nordic countries and other countries worldwide. Methods: In this study, a Nordic cross-national network of researchers collaborated in investigating policy documents at the national and university levels, which govern the education of ECEC teachers. This study was inspired by the Non-affirmative Theory of Education, which provides a framework for understanding the various influences on curricular development in higher education. Based on this, a four-step comparative analytical process of national and university documents across the Nordic countries was conducted. It included keyword search for MoPA related courses and a qualitative description of MoPA in ECTE. Thus, a combination of investigations of policy documents at the national and university level and expert knowledge set a solid foundation for international comparison. Results: The comparative analysis of MoPA in ECTE reveals diverse approaches influenced by national and university policies. A central theme is the variability in MoPA integration across these nations. Finland and Norway prioritize MoPA with independent mandatory courses. In Iceland, compulsory MoPA courses exist at one of two universities, and in Sweden at three out of 19. All university colleges in Denmark offer an elective course. Furthermore, learning objectives related to MoPA are, to varying degrees, part of the internships in the countries, with Sweden being an exception. In the participating countries, the teachers decide the content of the MoPA courses with little guidance, support, and agreement on essential MoPA content within and across the ECTE's. Norway has established guidelines, and in Finland, there is a network of ECTE Physical Education (PE) educators, which, to some degree, increases the consistency and quality of MoPA in education. Discussion: The Nordic countries present diverse MoPA integration approaches rooted in national policies and educational traditions. The findings emphasize the necessity of independent and mandatory MoPA courses, integration of MoPA into internships and promoting networks across the educational and academic sectors to equip future early childhood educators with competencies for fostering physical activity, motor development and children's well-being.

Parental Access to Healthcare following Paediatric Surgery-The Precarious Role of Parents as Providers of Care in the Home.

Access to healthcare can facilitate parents' self-management of their children's care. Healthcare access can be described as consisting of six dimensions: approachability, acceptability, affordability, availability, appropriateness, and aperture. The aim of this study was to analyse these dimensions of healthcare access experienced by parents caring for their children at home following paediatric surgery. The method-directed content analysis, conducted with the six-dimensional framework of access to healthcare as a guide, was used to analyse twenty-two interviews with parents of children treated with paediatric surgery. All six dimensions were represented in the results. Acceptability was the most frequent dimension, followed by appropriateness and approachability. Affordability, availability, and aperture were less represented. Although access to healthcare after paediatric surgery is generally appropriate and approachable, parents may experience insecurity in performing the self-management needed. Complementary forms of information provision, e.g., telemedicine, can be valuable in this regard.

Development of a prognostic model of COVID-19 severity: a population-based cohort study in Iceland.

BACKGROUND: The severity of SARS-CoV-2 infection varies from asymptomatic state to severe respiratory failure and the clinical course is difficult to predict. The aim of the study was to develop a prognostic model to predict the severity of COVID-19 in unvaccinated adults at the time of diagnosis. METHODS: All SARS-CoV-2-positive adults in Iceland were prospectively enrolled into a telehealth service at diagnosis. A multivariable proportional-odds logistic regression model was derived from information obtained during the enrollment interview of those diagnosed between February 27 and December 31, 2020 who met the inclusion criteria. Outcomes were defined on an ordinal scale: (1) no need for escalation of care during follow-up; (2) need for urgent care visit; (3) hospitalization; and (4) admission to intensive care unit (ICU) or death. Missing data were multiply imputed using chained equations and the model was internally validated using bootstrapping techniques. Decision curve analysis was performed. RESULTS: The prognostic model was derived from 4756 SARS-CoV-2-positive persons. In total, 375 (7.9%) only required urgent care visits, 188 (4.0%) were hospitalized and 50 (1.1%) were either admitted to ICU or died due to complications of COVID-19. The model included age, sex, body mass index (BMI), current smoking, underlying conditions, and symptoms and clinical severity score at enrollment. On internal validation, the optimism-corrected Nagelkerke's R2 was 23.4% (95%CI, 22.7-24.2), the C-statistic was 0.793 (95%CI, 0.789-0.797) and the calibration slope was 0.97 (95%CI, 0.96-0.98). Outcome-specific indices were for urgent care visit or worse (calibration intercept -0.04 [95%CI, -0.06 to -0.02], Emax 0.014 [95%CI, 0.008-0.020]), hospitalization or worse (calibration intercept -0.06 [95%CI, -0.12 to -0.03], Emax 0.018 [95%CI, 0.010-0.027]), and ICU admission or death (calibration intercept -0.10 [95%CI, -0.15 to -0.04] and Emax 0.027 [95%CI, 0.013-0.041]). CONCLUSION: Our prognostic model can accurately predict the later need for urgent outpatient evaluation, hospitalization, and ICU admission and death among unvaccinated SARS-CoV-2-positive adults in the general population at the time of diagnosis, using information obtained by telephone interview.

Randomized clinical trial of musical distraction with and without headphones for adolescents' immunization pain.

Distraction has shown to be a helpful pain intervention for children; however, few investigations have studied the effectiveness of this method with adolescents. The aim of this study was to evaluate the usefulness of an easy and practical musical distraction in reducing adolescents' immunization pain. Furthermore, to examine whether musical distraction techniques (with or without headphones) used influenced the pain outcome. Hundred and eighteen 14-year-old adolescents, scheduled for polio immunization, participated. Adolescents were randomly assigned to one of three research groups; musical distraction with headphones (n=38), musical distraction without headphones (n=41) and standard care control (n=39). Results showed adolescents receiving musical distraction were less likely to report pain compared to the control group, controlling for covariates. Comparing musical distraction techniques, eliminating headphone emerged as a significant predictor of no pain. Results suggest that an easy and practical musical distraction intervention, implemented without headphones, can give some pain relief to adolescents during routine vaccination.

Movement and Physical Activity in Early Childhood Education and Care Policies of Five Nordic Countries.

The purpose of this study was to examine the values of movement and physical activity (MoPA) using government policy documents (e.g., laws and curricula) on early childhood education and care (ECEC) from Denmark, Finland, Iceland, Norway, and Sweden. This descriptive, comparative study was designed based on curriculum theory and used word count and content analyses to identify similarities and differences in the occurrence of MoPA in the ECEC policies of Nordic countries. Seven terms were identified as MoPA-related in Nordic policy documents. These terms occurred in various content contexts: development, environment, expression, health and well-being, learning and play, albeit sparsely. MoPA was referred to as both a goal in and of itself and as a means of achieving other goals (e.g., learning or development in another area). Formulations specifically dedicated to MoPA as a goal were present in the Danish and Finnish curricula and, to some extent, also in the Norwegian curriculum, while the Icelandic and Swedish curricula mentioned MoPA mostly as a means. Findings indicated that MoPA, which is important for children's development, health, and well-being, is a low-priority value, to varying degrees, in the ECEC policies enacted by Nordic countries and the guidance provided to educators and stakeholders therein is inexplicit.

Monoclonal gammopathy of undetermined significance and COVID-19: a population-based cohort study.

Multiple myeloma (MM) patients have increased risk of severe coronavirus disease 2019 (COVID-19) when infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Monoclonal gammopathy of undetermined significance (MGUS), the precursor of MM has been associated with immune dysfunction which may lead to severe COVID-19. No systematic data have been published on COVID-19 in individuals with MGUS. We conducted a large population-based cohort study evaluating the risk of SARS-CoV-2 infection and severe COVID-19 among individuals with MGUS. We included 75,422 Icelanders born before 1976, who had been screened for MGUS in the Iceland Screens Treats or Prevents Multiple Myeloma study (iStopMM). Data on SARS-CoV-2 testing and COVID-19 severity were acquired from the Icelandic COVID-19 Study Group. Using a test-negative study design, we included 32,047 iStopMM participants who had been tested for SARS-CoV-2, of whom 1754 had MGUS. Among these participants, 1100 participants, tested positive, 65 of whom had MGUS. Severe COVID-19 developed in 230 participants, including 16 with MGUS. MGUS was not associated with SARS-CoV-2 infection (Odds ratio (OR): 1.05; 95% confidence interval (CI): 0.81-1.36; p = 0.72) or severe COVID-19 (OR: 0.99; 95%CI: 0.52-1.91; p = 0.99). These findings indicate that MGUS does not affect the susceptibility to SARS-CoV-2 or the severity of COVID-19.

The social context of drunkenness in mid-adolescence.

AIMS: The aim of the study was to assess sociodemographic, parental and peer predictors of self-reported drunkenness in mid-adolescence. METHODS: The data were obtained from a national school survey covering a random half of all Icelandic 9th and 10th grade students (mean age 14.7 years). The overall response rate was 92% (n = 3,913). RESULTS: 30% of the respondents reported having been drunk or intoxicated at least once during the 30-day period prior to the survey. Multivariate logistic regression analysis showed that living with a single father, or in an urban area; having friends who get drunk or accept drunkenness; being supported by friends; having a father who gets drunk; having parents who assent to drunkenness; and lacking support from parents, were significantly associated with drunkenness. The strongest predictors of drunkenness were drunkenness among friends and friends' acceptance of drinking. The study did not find significant differences in the odds of drunkenness by gender or parental education. Students in 10th grade had higher odds of drunkeness than 9th grade students, which was accounted for by different family and peer contexts of younger and older adolescents. CONCLUSIONS: Residence, family structure, high peer support, peer acceptance, peer drunkenness, parental acceptance, father drunkenness, and low parental support was related to higher odds of drunkenness in mid-adolescents. The results give directions to future research and interventions intended to prevent alcohol abuse in this population.

Living with the Memories-Parents' Experiences of Their Newborn Child Undergoing Heart Surgery Abroad: A Qualitative Study.

Parents of children with a congenital heart defect needing complex heart surgery are at high risk of developing health problems. One can assume that parents whose child undergoes heart surgery abroad will undoubtably face added and unique stressors and health vulnerabilities. The aim of this qualitative study was to explore the transition experiences of parents of children who underwent a complex heart surgery abroad as newborns 1-5 years ago. The qualitative content analysis methodology by Graneheim and Lundman was used. A purposive sample of twelve parents, whose child had undergone a heart surgery abroad, participated in face-to-face, semi-structured interviews. Interviews were transcribed and analyzed using inductive qualitative content analysis. The overarching theme of "living with the memories" emerged from parents' experiences, emphasizing the long-lasting impact this stressful event had on their lives. These experiences were characterized by four main categories: (1) being in an unknown situation; (2) feeling connected; (3) wishing to be accepted; and (4) finding closure. The findings show that the transition of having a newborn child undergo heart surgery abroad superimposed on the expected parenthood. That parents need to feel connected and included as legitimate clients was highlighted in their stories of experienced vulnerabilities. The results highlight the need for interdisciplinary teams to support these vulnerable families, particularly with follow-up care.

Clinical spectrum of coronavirus disease 2019 in Iceland: population based cohort study.

OBJECTIVE: To characterise the symptoms of coronavirus disease 2019 (covid-19). DESIGN: Population based cohort study. SETTING: Iceland. PARTICIPANTS: All individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) between 17 March and 30 April 2020. Cases were identified by three testing strategies: targeted testing guided by clinical suspicion, open invitation population screening based on self referral, and random population screening. All identified cases were enrolled in a telehealth monitoring service, and symptoms were systematically monitored from diagnosis to recovery. MAIN OUTCOME MEASURES: Occurrence of one or more of 19 predefined symptoms during follow-up. RESULTS: Among 1564 people positive for SARS-CoV-2, the most common presenting symptoms were myalgia (55%), headache (51%), and non-productive cough (49%). At the time of diagnosis, 83 (5.3%) individuals reported no symptoms, of whom 49 (59%) remained asymptomatic during follow-up. At diagnosis, 216 (14%) and 349 (22%) people did not meet the case definition of the Centers for Disease Control and Prevention and the World Health Organization, respectively. Most (67%) of the SARS-CoV-2-positive patients had mild symptoms throughout the course of their disease. CONCLUSION: In the setting of broad access to RT-PCR testing, most SARS-CoV-2-positive people were found to have mild symptoms. Fever and dyspnoea were less common than previously reported. A substantial proportion of SARS-CoV-2-positive people did not meet recommended case definitions at the time of diagnosis.