Nurses' experience during the COVID-19 pandemic and consequences on their relationship with patients. Consensual qualitative research / Vécu des infirmières lors de la pandémie de COVID-19 et conséquences sur leur relation avec les patients : une recherche qualitative consensuelle

Much the same as other healthcare services, when the COVID-19 pandemic hit, psychiatric hospitals implemented significant and rapid changes in the organization of their services. The aim of this research study is to describe and understand the experience of nurses and nursing supervisors in psychiatric units in the light of the occupational transformations caused by the first wave of the COVID-19 pandemic, as well as the impact of these events on their relationships with patients. A consensual qualitative research study based on Hill's model was implemented. Sixteen individual interviews were conducted with eleven nurses and five nursing supervisors. The themes discussed can be grouped into five areas: aspects of the caregiving relationship, positive aspects of caregivers' experiences, negative aspects of caregivers' experiences, reflections on the post-pandemic era, and the role of supervisors. These five areas can be subdivided into 11 categories and 31 subcategories. Values, attitudes, and behaviors centered around a humanistic caring approach are identified as integral to future development. They appear to be elements of both the transformation process and the desired outcome. In light of these findings, it seems that an immediate rethink of the organization of care is needed.

Dans les hôpitaux psychiatriques, des modifications importantes et rapides de l'organisation des services ont été décidées dès le début de la pandémie de COVID-19. Le but de cette recherche est de décrire et comprendre le vécu des infirmières et cadres de santé, en unités intrahospitalières de psychiatrie, confrontés aux bouleversements professionnels occasionnés par la première vague de l'épidémie, ainsi que l'impact de cet événement sur la relation avec les patients. Une recherche qualitative consensuelle selon Hill a été mise en œuvre. Seize entretiens individuels ont été réalisés auprès de onze infirmières et cinq cadres de santé. Les idées exprimées peuvent être regroupées en cinq domaines : les aspects du vécu se rapportant à la relation de soins, les aspects positifs du vécu des soignants, les aspects négatifs du vécu des soignants, les réflexions sur l'après-crise et le rôle du cadre remis en question. Ces cinq domaines peuvent être subdivisés en 11 catégories et 31 sous-catégories. Des valeurs, attitudes et comportements humanistes ­ caring ­ sont identifiés comme faisant partie d'un futur désirable. Ils semblent être à la fois des éléments du processus de transformation et du résultat souhaité. Il parait indispensable de repenser sans délais l'organisation des soins sur cette base.

The care experience for people undergoing a liver transplantation. Descriptive phenomenological investigation in a Belgian academic hospital / L'expérience des soins des personnes qui vivent une transplantation hépatique. Recherche phénoménologique descriptive au sein d'un hôpital académique belge

This study aims to describe and understand the care experience for people having undergone a liver transplantation in a Belgian academic hospital and the elements of an ideal care experience for them. The descriptive phenomenological method of the « Relational Caring Inquiry ¼ was used with twelve participants whose stories were collected through three semi-structured individual interviews. These interviews gave an overall picture of their care experience, summarized as « the feeling of having benefited from the support of both the body and mind in a Humanist-Caring dynamic, but with difficulties linked to organizational and environmental factors in finding a new balance. ¼ The essence of their ideal care experience consists of « benefiting from the support of both the body and mind by competent professionals, in a Humanist-Caring climate and a dynamic of partnership with the patient, in an institution that is welcoming in terms of its organization and environment. ¼ Based on these results, it seems essential to limit organizational constraints to consolidate the Humanist-Caring dynamic, to develop the patient partnership, and to pay special attention to the patient's relatives, resulting in structured support.

Cette étude vise à décrire et comprendre l'expérience des soins des personnes ayant vécu une transplantation hépatique dans un hôpital académique belge, ainsi que ce qui constituerait pour eux les éléments d'une expérience idéale des soins. La méthode phénoménologique descriptive « Investigation Relationnelle Caring ¼ a été utilisée auprès de douze participants dont le récit a été recueilli, pour chacun, au moyen de trois entrevues individuelles semi-dirigées. Cela a permis d'élucider l'essence globale de leur expérience des soins, résumée comme « le sentiment d'avoir bénéficié d'un accompagnement du corps et de l'esprit dans une dynamique humaniste-caring, mais d'éprouver cependant des difficultés à retrouver un nouvel équilibre, liées à des facteurs organisationnels et environnementaux ¼. Quant à l'essence de leur expérience idéale des soins, elle consiste à « bénéficier d'un accompagnement du corps et de l'esprit par des professionnels compétents, dans un climat humaniste-caring, et une dynamique de partenariat avec le patient et ses proches, dans une institution accueillante sur le plan organisationnel et environnemental. ¼ Partant de ces résultats, il semble important de limiter les contraintes organisationnelles pour consolider la dynamique humaniste-caring, de développer le partenariat patient et de porter une attention particulière aux proches des patients, qui se traduise par un accompagnement structuré.

Weaning of maintenance immunosuppressive therapy in lupus nephritis (WIN-Lupus): results of a multicentre randomised controlled trial.

OBJECTIVES: Lupus nephritis (LN) is a frequent complication of systemic lupus erythematosus (SLE). Severe (proliferative) forms of LN are treated with induction immunosuppressive therapy (IST), followed by maintenance IST, to target remission and avoid relapses. The optimal duration of maintenance IST is unknown. The WIN-Lupus trial tested whether IST discontinuation after 2‒3 years was non-inferior to IST continuation for two more years in proliferative LN. METHODS: WIN-Lupus was an investigator-initiated multicentre randomised controlled trial. Patients receiving maintenance IST with azathioprine or mycophenolate mofetil for 2-3 years, and hydroxychloroquine, were randomised (1:1) into two groups: (1) IST continuation and (2) IST discontinuation. The primary endpoint was the relapse rate of proliferative LN at 24 months. Main secondary endpoints were the rate of severe SLE flares, survival without renal relapse or severe flare, adverse events. RESULTS: Between 2011 and 2016, 96 patients (out of 200 planned) were randomised in WIN-Lupus: IST continuation group (n=48), IST discontinuation group (n=48). Relapse of proliferative LN occurred in 5/40 (12.5%) patients with IST continuation and in 12/44 (27.3%) patients with IST discontinuation (difference 14.8% (95% CI -1.9 to 31.5)). Non-inferiority was not demonstrated for relapse rate; time to relapse did not differ between the groups. Severe SLE flares (renal or extrarenal) were less frequent in patients with IST continuation (5/40 vs 14/44 patients; p=0.035). Adverse events did not differ between the groups. CONCLUSIONS: Non-inferiority of maintenance IST discontinuation after 2‒3 years was not demonstrated for renal relapse. IST discontinuation was associated with a higher risk of severe SLE flares. TRIAL REGISTRATION NUMBER: NCT01284725.

Émotions des infirmières au chevet des malades hospitalisés pour la COVID-19. Recherche qualitative consensuelle.

The COVID-19 pandemic has created unprecedented working conditions, with repercussions on the daily lives of nurses. The events experienced positively or negatively in their clinical practice have aroused a variety of emotions for them. The objective of this research is to describe and categorize the events that provoked emotions in nurses who volunteered to accompany COVID-19 victims in a Belgian academic hospital during the first wave of the pandemic by identifying what these emotions were. The researchers used Hill's Consensual Qualitative Research method. Nineteen semi-structured individual interviews were conducted. After the full transcription of the recordings, the data were analyzed by the research team. The results show that the emotions felt by the participants were caused by thirty-seven types of events (categories) grouped into nine families (domains). COVID-19 is viewed negatively by the participants who express fear of this serious and contagious disease. When they talk about the experiences of patients and their families, their discourse alternates between joy at having been able to provide help and care and sadness at not having been able to be effective in all circumstances. Participants share a positive experience and express joy in recalling the COVID-19 outbreak as an exceptional event that they coped with through their personal and professional experience and resources, their relationships with colleagues on the interprofessional team, and the responses of the nursing department and hospital.

Win/win partnerships between Geneva health-related institutions and caregivers of people with dementia: a descriptive cross-sectional study.

BACKGROUND: In the context of an ageing population and an increase in the appearance of chronic diseases, the commitment of caregivers makes it possible for people confronted with disease to remain at home. Over time, they need support to overcome their difficulties. They also show a need for recognition for their participation in the economic maintenance of the health system. To promote this support, so-called "win/win" partnerships are envisaged. Research is needed to identify the building blocks of an innovative intervention. METHODS: A cross-sectional descriptive study was carried out with health institutions in the canton of Geneva to identify the proportion of institutions with a positive opinion on partnership with caregivers. It has also identified potential partnerships with caregivers of people facing dementia and possible compensation in exchange for the provision of their skills. Descriptive statistics are presented according to their frequencies and relative percentages (categorical variables), as well as by their mean, standard deviation and median (continuous variables). Logistic regression models were used to assess the factors associated with a favorable opinion towards win/win partnerships. RESULTS: The proportion of executives of health-related institutions with a positive opinion of partnership with caregivers is high: 74.7% (95% CI: 64.8-83.1%). Several types of potential partnerships have been identified between health institutions and caregivers. Areas in which certain activities have been identified as being able to be carried out by caregivers include governance, care, provision of services, accompaniment and support, training and research. Types of compensation for caregivers have also been highlighted. CONCLUSION: This study shows that some areas activities of health facilities in the canton of Geneva could be the subject of win-win partnerships with caregivers of people with dementia. Positive view of health executives on partnership with caregivers is encouraging. In the future, innovative projects can emerge to meet the needs of each party.

Factors Affecting Interprofessional Teamwork in Emergency Department Care of Polytrauma Patients: Results of an Exploratory Study.

Considering that traumatic injuries are the leading cause of death among young adults across the globe, emergency department care of polytrauma patients is a crucial aspect of optimized care and premature death prevention. Unfortunately, many studies have highlighted important gaps in collaboration among different trauma team professionals, posing a major quality-of-care challenge. Using the conceptual framework for interprofessional teamwork (IPT) of , the aim of this qualitative descriptive exploratory study was to better understand IPT from the perspective of health professionals in emergency department care of polytrauma patients, specifically by identifying factors that facilitate and impede IPT. Data were collected from a sample of 7 health professionals involved in the care of polytrauma patients through individual interviews and a focus group. In the second phase, 2 structured observations of polytrauma patient care were conducted. Following a thematic analysis, results revealed multiple factors affecting IPT, which can be divided into 5 broad categories: individual, relational, processual, organizational, and contextual. Individual factors, a category that is not part of the conceptual framework of , also emerged as playing a major part in IPT.

Partnership between patients, nurse leaders and researchers: Outcomes of a web-based KT strategy for hospital discharge planning and care transitions in oncology.

A research project brought together patient partners, nurse leaders from six clinical settings in Quebec and researchers to develop and test a web technology, the Forum for Knowledge Exchange (FKE), in order to improve discharge planning practices and oncological care transitions. The project led to the creation of a FKE accessible to the oncology sector of the Francophonie. It revealed an innovative strategy of knowledge transfer (KT) based on the FKE and was fed by collaborative work among partners, where the patient partners played a vital role. The results highlighted the importance, for health research, of giving a voice to patient partners in close collaboration with clinicians and researchers so that clinical practices are better adapted to the actual needs of patients and of their relatives.

[People living with chronic asthma: Needs and expectations regarding the accompaniment offered by Belgian health professionals.] / Besoins et attentes des personnes vivant avec un asthme chronique quant à l'accompagnement proposé par les professionnels de la santé belges.

INTRODUCTION: Asthma remains a major public health problem, with 300 million people affected worldwide and a low rate of adherence to treatment. CONTEXT: Few authors have considered one of the determinants of asthmatic patients' adherence to treatment : the accompaniment offered by health care professionals. AIM: To describe the expectations and needs of people living with chronic asthma regarding their accompaniment. METHODS: A descriptive qualitative approach with reasoned sampling. Eight individual semi-structured interviews were conducted among chronic asthmatic adult patients and analyzed by an inductive approach. This was submitted to participants for validation. RESULTS: Needs and expectations are branched out into six main themes : the wish to establish a trusting relationship, the need to perceive professional competence, the importance of the professional's availability, the wish to be more involved in one's life with the disease, the desire for the professional to adopt a humanist posture and to take into account patient singularity. CONCLUSION: A better understanding of non-met expectations would help the adherence to treatment rate to improve. This qualitative research opens various avenues for reflection that are worth thinking about and provides the breeding ground for other studies.

Does age matter? A mixed methods study examining determinants of good recovery and resilience in young and middle-aged adults following moderate-to-severe traumatic brain injury.

AIM: To examine whether age contributes to functional recovery and resilience after moderate-to-severe traumatic brain injury. BACKGROUND: The ability to recover may change across the lifespan, but the influence of age on brain injury outcome is understudied. DESIGN: Mixed methods study. METHODS: All adults of working age (18-64 years) discharged from a level I trauma centre between 2010-2013 after sustaining a moderate-to-severe traumatic brain injury were considered. Functional recovery was assessed during a telephone interview with the Glasgow Outcome Scale-Extended 12-36 months postinjury. A subgroup completed the Connor-Davidson Resilience Scale and a face-to-face interview about resilience. RESULTS: Ninety-seven young (mean age: 27 years; 75% male) and 47 middle-aged brain trauma survivors (mean age: 53 years; 75% male) completed the telephone interview. Eight young and five middle-aged adults were also assessed for resilience. Overall, young participants experienced more severe head injuries. Yet, they achieved slightly higher levels of functional recovery compared with middle-aged ones as per the Glasgow Outcome Scale-Extended. Controlling for CT scan findings and posttraumatic amnesia duration, age was not found to be associated to functional recovery in adults of working age. Although both groups showed similar levels of resilience, young participants discussed the challenges related to "having more time on their hands" and "being a changed person", two elements perceived positively by middle-aged ones. CONCLUSION: While age does not appear to interfere with functional recovery in adults of working age, younger brain trauma survivors could benefit from nursing interventions to strengthen their resilience process related to re-employment orientation and identity.

Mandatory internal mobility in French hospitals: the results of imposed management practices.

AIM: To describe the impact of a mandatory internal mobility policy on nurses working in French state-funded health establishments. BACKGROUND: Public hospitals in France rely on the internal mobility of nursing staff to respond to organisational needs, to reduce costs and to increase productivity. However, there is very little data on the impact of such management practices on the nurses themselves. METHOD: A cross-sectional study, including 3077 nurses from 35 hospitals in the region of Paris, was conducted. Data were collected using a validated self-assessment questionnaire. RESULTS: Forty per cent of French nurses are required to work in different units. This mobility differs according to individual characteristics [age (P = 0.04), length of service (P = 0.017)] and type of environment [hospital (P < 0.0001), specialty (P < 0.0001)]. CONCLUSION: We can distinguish two types of approaches for implementing a mandatory staff nurse mobility policy. The first is an event that is regular, planned and lasts for several days. The second is an event that is irregular, short and organised the day before or the day of the change. Overall, while nurses are dissatisfied with all types of mandatory unit changes, this dissatisfaction is primarily a result of the irregular mobility events. IMPLICATIONS FOR NURSING MANAGEMENT: This study demonstrates the importance of implementing a planned inter-unit mobility event and proposes recommendations for this type of implementation.

[Interprofessional collaboration in the management of a polytrauma at the emergency department : a literature review.] / La collaboration interprofessionnelle lors de la prise en charge d'un polytraumatisé aux urgences : une revue de la littérature.

INTRODUCTION: interprofessional collaboration (IPC) in the context of trauma remains a challenge for health care professionals who must react quickly and prioritize interventions according to trauma practice standards. METHODS: a review of the literature was conducted by exploring the CINAHL, Scopus, Web of Science and Pubmed databases in relation to trauma and IPC in order to report on IPC knowledge in the context of traumatology. RESULTS: a significant number of articles related to traumatology (n = 14), to IPC (n = 38) and then related to these two themes (n = 15) were identified and analyzed. CONCLUSION: few studies have addressed IPC in the context of trauma. The authors did seem to pay particular attention to the role of the trauma team leader and to the leadership competence, while others are more interested in communication and perceptions of the different health professional roles. In addition, these papers mainly demonstrate that many gaps remain within interprofessional trauma teams, such as communication, coordination of care and role clarification.

[Panorama of the Nursing Models used by Chief Nursing Officers in bilingual and French speaking Belgian hospitals.] / Panorama des modèles de soins infirmiers utilisés par les chefs de département infirmier dans les hôpitaux belges francophones et bilingues.

The use of a Nursing Model (NM) for nursing administration offers direct and indirect benefits for patients as for nurses. Depending the chosen NM, the concepts of person, health, nursing and environment are very different. Each NM has its special vision of the practice of nursing. The study investigated whether the Chief Nursing Officers (CNO) of the bilingual and French speaking Belgian hospitals integrate Nursing Models in the politics of their department. A quantitative descriptive and correlational survey was conducted. 97.5 % of the concerned CNO (78/80) participated to the research. It appears that a Nursing Model underlies the action of the nursing department in only 38 % of the departments (30/78). Where a Nursing Model is used, it is explicitly communicated to staff (26/30). Among the Models used, that of Virginia Henderson dominates (26/30). The seniority of the CNO in its function as well as variables related to educational courses and clinical context appear to influence the results. The Nursing Models of the paradigm of transformation remain rarely used. A qualitative research would be relevant to deepen the understanding of the experience of CNO related to Nursing Models.

[The Humanistic Model of Nursing Care - UdeM : an innovative and pragmatic perspective]. / Le Modèle humaniste des soins infirmiers -UdeM : perspective novatrice et pragmatique.

As in many other countries, Québec is not immune to healthcare reforms, which can unfortunately hinder quality of care as well as induce some dehumanization, both for the patients and the healthcare professionals. Thus, the « Humanistic Model of Nursing Care - UdeM ¼ (HMNC-UdeM) aspires to offer an innovative perspective that aims at improving the quality and the safety of care, in addition to satisfaction and well-being for both patients and nurses. While respecting their theoretical influences, the authors present their vision of the central concepts of the discipline and the Model's key concepts, seeking to make them more understandable, accessible, and applicable in nurses' daily practice. Therefore, the aim of this article is to raise awareness of the Model into the nursing community, to promote its implantation in nursing's spheres of activities, in addition to demonstrate its applicability and impact in nursing research. It appears that this model is promising for the renewal and the development of humanistic interventions for patients' care.

Impact of the Provision of Safe Drinking Water on School Absence Rates in Cambodia: A Quasi-Experimental Study.

BACKGROUND: Education is one of the most important drivers for helping people in developing countries lift themselves out of poverty. However, even when schooling is available absenteeism rates can be high. Recently, focus is being given on whether or not WASH interventions can help reduce absenteeism in developing countries. However, none has focused exclusively on the role of drinking water provision. We report a study on the association between absenteeism and provision of treated water in containers maintained in schools. METHODS AND FINDINGS: We undertook a quasi-experimental longitudinal study of absenteeism rates in 8 schools, 4 of which received one 20 l container of treated drinking water per day. The water had been treated by filtration and ultraviolet disinfection. Weekly absenteeism rates were compared across all schools using the negative binomial model in generalized estimating equations. There was a strong association between the provision of free water and reduced absenteeism (Incidence rate ratio = 0.39 (95% confidence intervals 0.27-0.56)). However, there was also a strong association with season (wet versus dry) and a significant interaction between receiving free water and season. In one of the intervention schools, it was discovered that the water supplier was not fulfilling his contract and was not delivering sufficient water each week. In this school, we showed a significant association between the number of water containers delivered each week and absenteeism (IRR = 0.98 95% CI 0.96-1.00). CONCLUSION: There appears to be a strong association between providing free and safe drinking water and reduced absenteeism, although only in the dry season. The mechanism for this association is not clear but may be in part due to improved hydration leading to improved school experience for the children.

Resilience in Families With Adolescents Suffering From Traumatic Brain Injuries.

PURPOSE: This study aims to coconstruct the building blocks for an intervention program to support family resilience in conjunction with families with an adolescent suffering from traumatic brain injury and rehabilitation professionals. DESIGN: This is a qualitative and inductive study, supported by a collaborative research approach. METHODS: Based on the complex intervention design and validation model, the investigator follows a three-stage data collection process: (1) identifying the building blocks of the intervention program in the eyes of families and rehabilitation professionals, (2) prioritizing, and (3) validating the building blocks with the same participants. FINDINGS: After analyzing the data, the investigator identifies five encompassing themes as the building blocks of the intervention program. CONCLUSIONS/CLINICAL RELEVANCE: This study offers promising avenues for practitioners and researchers in nursing and other fields with respect to the implementation of concrete strategies to support the resilience process of families facing particularly difficult times in their lives.

Water source and diarrhoeal disease risk in children under 5 years old in Cambodia: a prospective diary based study.

BACKGROUND: Despite claims that the Millennium Development Goals (MDG) targets on access to safe drinking water have been met, many 100 s of millions of people still have no access. The challenge remains how to provide these people and especially young children with safe drinking water. METHOD: We report a longitudinal study designed to assess the effectiveness of an intervention based on provided treated drinking water in containers on self-reported diarrhoea in children. The intervention was "1001 fontaines pour demain" (1001 F) is a non-governmental not for profit organization (created in 2004 and based in Caluire, France) that helps local entrepreneurs treat package, and sell safe drinking water. Cases and controls were chosen at village and household level by propensity score matching Participants were visited twice a month over six months and asked to complete a diarrhoea health diary. RESULTS: In total 4275 follow-up visits were completed on 376 participants from 309 homes. Diarrhoea was reported in 20.4% of children on each visit, equating to an incidence rate estimate of 5.32 episodes per child per year (95% confidence interval = 4.97 to 5.69). Compared to those drinking 1001 F water, children drinking surface water were 33% (95% CI -1 to 17%), those drinking protected ground water were 62% (95% CI 19 to 120%) and those drinking other bottled water 57% (95% CI 15 to 114%) more likely to report diarrhoea. Children drinking harvested rainwater had similar rates of diarrhoea to Children drinking 1001 F water. CONCLUSION: Our study suggests that 1001 F water provides a safer alternative to groundwater or surface water. Furthermore, our study raises serious concerns about the validity of assuming protected groundwater to be safe water for the purposes of assessing the MDG targets. By contrast our study provides addition evidence of the relative safety of rainwater harvesting.

[Perceived needs and social participation of people with mild traumatic brain injury]. / Besoins perçus et participation sociale des personnes ayant un traumatisme crânien léger.

INTRODUCTION: Only limited data are available concerning the perception of quality of life and social participation of people with mild Traumatic Brain Injury (mTBI). The APIC personalized community integration support programme encourages people with TBI to achieve significant daily living or leisure activities. OBJECTIVES: To explore the social participation needs and expectations of people with mTBI. METHODS: 1) Qualitative multiple-case study; 2) Questionnaires based on Assessment of Activities of Daily Living Profile, Leisure Profile and Life Habits in the form of semi-structured interviews. RESULTS: Participants reported deterioration of their quality of life after the accident, especially affecting leisure activities and social role. They would like to have someone to help reduce their loneliness, reassure them and motivate them to start changing their lives. DISCUSSION: Unlike the main interventions provided by the social welfare and healthcare system and relatives, people with mTBI express the need for reassuring activities in public places to help them regain their social role and accept their new identity.