Child abuse during the COVID-19 pandemic-Prospect, risk and factors: A narrative review

This narrative review focuses on the risk of child abuse, the determinants of child maltreatment during the Covid-19 outbreak and the conceivable psycho-social impact of child abuse. Literature was retrieved from Scopus, PubMed, PsycINFO, Web of Science along with Google Scholar, and reports from various sources with no time and context restrictions. The narrative analysis of all pertinent records shows that the risk of abuse towards children has spiked during the Covid-19 outbreak, especially sexual abuse and neglect. Prolonged living inside of homes, school closures, limited contact, unemployment, domestic violence, poor access to health care, and related social stressors have impacted on the rates of child abuse during the Covid-19 outbreak. These maltreated children may experience poor interpersonal relationships, problematic coping behaviours, and depressive disorders across their life span. These findings point to context-specific outcomes and protective measures that could assist prospective researches and guide policies. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The invisible issue, children, and families in substandard accommodation: how can paediatric interdisciplinary teams help?

AimsIn the UK the number of children living in temporary accommodation has risen by 80% since COVID-19 [1]. One fifth of Australian children aged 0 to 5 years lived in homelessness/housing instability prior to COVID-19 [2,3]. Little is known regarding the impact of homelessness on the health of children living with homeless families. Moreover, the types of services and interprofessional collaborations needed to address children’s needs remains unknown [3,4]. This presentation outlines an innovative model of interdisciplinary collaborative health delivery that addresses these gaps [5]. The model used an embedded Nurse Practitioner ‘health hub’ to assess children and help parents meet their child’s needs.Objectives: This project captured the:1. Health of homeless children presenting to homelessness and community services in South Australia.2. Referral rates and uptake of the children3. Interdisciplinary health needs of the children living with homeless familiesMethodsA mixed methods study design was conducted. Health severity scales, extended health assessments, case note reviews, and interviews with parents and staff, to determine the health impacts of homelessness on children and the children’s interdisciplinary health needs. The conditions identified were coded using a severity scale of 1 to 3;3= severe, the child needing immediate care/intervention, 2= moderate, the child needs a referral but can wait for public hospital/clinic, 1= minor, the child does not need immediate referral). Referrals were made to: Paediatricians, dentists, physiotherapists, immunisation nurses, General Practitioners and other allied health professionals.ResultsOverall interim results show 62% of children presenting had health conditions (e.g. chronic dental caries, craniosynostosis with developmental delay) requiring interventions, while 38% were assessed as having good health requiring no intervention.Table 1 above illustrates the presenting conditions of the children attending the Nurse Practitioner led clinic. A consultation with the NP for an in-depth health assessment and often were the first comprehensive health assessment the children had received since birth.We found 18% children had a developmental delay (6 times the national average), 17% had behavioural and/or mental health issues, 17% required an ENT intervention, 24% had dental issues and 24% had a variety of presenting conditions. The correlational analysis and odds ratio results along with the interdisciplinary model of care and the case note analysis will be presented at the RCPCH conference. The intervention/evaluation reflects the complexity and depth of the unmet need in these children.ConclusionOverall the children are disconnected from health. This research identified that:• A significant number of children required medical interventions.• Children living in housing insecurity are at risk of missing out on care that is essential to their development and health• These children lack access to mainstream services• Health care costs act as a barrier to services• There is a poor referral uptake by children living in housing insecurity• There is a lack of information on the number of homeless children, particularly Aboriginal childrenIt is imperative that the health needs of children living with housing instability are measured and the responses of health professional interventions are tracked.

Communicating about advance care planning to reduce overtreatment in the COVID-19 era: a rapid review

ObjectivesTo explore how the COVID-19 pandemic impacted communication around Advanced Care Planning (ACP). We sought to identify the barriers and enablers of ACP communication given the global crisis involving a previously-unknown, serious infection potentially leading to a surge in overtreatment.MethodsWe adopted the WHO recommendation of using rapid reviews for the production of actionable evidence. We searched PUBMED database to April 2021 and included all studies that focussed on ACP during COVID-19. Non-English articles were excluded. Titles and s were screened independently by two team members and full-texts selected by one author and reviewed by another. Quality was not appraised and risk-of-bias not formally conducted due to the rapid nature of this review. Studies were categorised for design and common themes were identified.ResultsFrom an original 323 s screened, 74 articles were included in this rapid review. The majority were commentary articles (n=39) and the rest were a mix of primary research studies (n=21) and reviews/guidelines (n=14). Most of the articles derived from the USA (n=49), followed by the UK (n=10), with other countries including India (n=3), Taiwan (n=2), Australia (n=2). The population settings included hospitals, outpatient services, residential aged care and community, indicating the widespread interest in ACP across all aspects of society during COVID-19. The main enablers of ACP communication identified included online tools and availability of telehealth. The development of new online tools and workshops encouraged community engagement with ACP during the COVID-19 pandemic. The expansion of telehealth services facilitated communication between patients, their families and physicians, relating to clinical condition, goals of care and treatment options. This allowed them to share decision-making in the setting of social distancing and visitor restrictions during the pandemic.Barriers to ACP communication during COVID-19 were more commonly described. Communication was made difficult by the clinical uncertainty around COVID-19, rapid patient deterioration and varied patient responses to treatment, often resulting in delayed ACP discussions. Complex medical jargon and complicated ACP forms also hindered ACP discussions during the pandemic. ACP uptake was shown to be lower in ethnic minorities and groups with lower socioeconomic status, likely due to language barriers, reduced familiarity with the health system and cultural reluctance to discuss death. Clinicians also experienced difficulties communicating about ACP, stemming from low levels of medical education in palliative care/end-of-life planning. Clinicians were reluctant to initiate ACP conversations, fearing they would extinguish hope of recovery. Shortage of personal protective equipment, visitor restrictions, clinician fatigue and high workload were further barriers to effective ACP communication.ConclusionsEffective communication around ACP during the pandemic, despite the challenges discussed, was found to facilitate end-of-life care in accordance with patient’s wishes, reduce anxiety and depression of bereaved relatives, and potentially prevent unwanted aggressive treatments, unnecessary hospital admissions and long periods of self-isolation. Recommendations to standardise ACP tools, engage a multi-disciplinary team to conduct ACP and increase ACP education for the community and clinicians will serve to further drive ACP conversations at the individual, local and international levels.

Where is community during COVID-19? The experiences of families living in housing insecurity.

This article explores the understanding of community to families living in insecure housing in one Australian state during the COVID-19 pandemic. Five female-headed families were interviewed during the pandemic and asked to identify what community meant to them. All participants were referred by an agency caring for families experiencing homelessness or housing insecurity. Community was defined using Bourdieu's concept of social capital, allowing for both bonding and bridging relationships to be explored. Bonding relationships refer to close emotional ties with family and friends, while bridging ties establish networks that provide individuals with access to resources. Two themes emerged that shed light on how community is understood during times of crisis: The first suggests that for families experiencing housing insecurity, particularly women escaping family violence, their links with community were primarily maintained by welfare and church agencies. These organisations provided bridging social capital during the pandemic that allowed the women and their children to cope with the isolation and to maximise opportunities. The second themes point to traditional notions of community as family and geographical space. Here the findings are mixed. Resources provided by government, and mediated through the welfare agency, allowed these families to create a safe and comfortable space. However, for First Nations women, the lockdown meant that it was difficult to maintain community obligations, while children who appeared to identify community with attendance at school found the lockdown confusing because of the disruption to their normal social space.

Missed infection control care and healthcare associated infections: A qualitative study

Background Research on missed nursing care reveals individual and systems failure. Research on infection control missed care is minimal. Aims Investigate nurse perceptions of missed infection control. Design Qualitative in-depth interviews with 11 Australian infection control nurse experts. Methods Participants were asked whether nursing and hospital-wide care tasks fundamental to infection control were missed, and what were the underlying causes and contributing factors for these omissions. Qualitative data was mapped against fundamental nursing practice and Australian infection control guidelines. Findings Omission of infection control care occur at the individual clinician and organisational level. Nurses describe failure to perform standard precautions as well as failure to perform basic care activities. Participants identified a range of institutional and cultural factors which contributed to cascade iatrogenesis resulting in healthcare associated infections for patients. Some factors are outside nurses’ control and include: environmental cleanliness;ward layout;ward culture;resourcing and staffing;integration of infection control into clinical governance;action following audit results;and reviewing evidence base of protocols. Discussion Care occurs in complex and conflicted settings, with prioritisation essential. Potentially harmful practices are generally done with the intention of care. Nurses are key, but not sole performers in the creation of quality infection control. Conclusion Mapping missed care related to infection control against standard frameworks of nursing practice revealed “gaps in the chain of infection” that contribute to “cascade iatrogenesis” with negative outcomes for patients.

Comparing infection control and ward nurses' views of the omission of infection control activities using the Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey.

AIM: To compare the perceptions of nurses with infection control expertise and ward nurses as to what infection control activities are missed and the reasons why these activities are omitted. BACKGROUND: Infection prevention activities are viewed as important for reducing health care-acquired infections (HAIs) but are often poorly performed. METHODS: Data were collected through the Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey delivered to 500 Australian nurses prior to COVID-19. RESULTS: Significant differences were found on the mean scores between infection control and other nurses on ten items. In eight cases, five relating to hand hygiene, infection control specialists viewed the activity as more likely to be missed. Factors viewed as having greater contribution to omission of infection control prevention were as follows: 'Patients have to share bathrooms', 'Urgent patient situation' and 'Unexpected rise in patient volume and/or acuity on the ward/unit'. Infection control nurses were more likely to highlight the role of organisational and management factors in preventing effective infection control. CONCLUSIONS: Differences in response between nurses suggest that the extent of omission of infection control precautions may be under-estimated by ward nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Infection control specialists are more likely to identify organisational barriers to effective infection control than other nurses. Work demands arising from pandemic management may contribute to infection control precautions being missed.