Patient navigation plus hospital at home to improve COVID-19 outcomes for cancer patients.

1524 Background: Reports suggested cancer patients were at greater risk for increased morbidity and mortality from COVID-19. A process to mitigate these risks was established at Levine Cancer Institute (LCI) in partnership with Atrium Health’s (AH) Hospital at Home (HAH) initiative. This virtual health navigation process employed expertise from the departments of Hematologic Oncology and Blood Disorders, Oncology, and Supportive Oncology, including a specialized nurse navigation team, to rapidly identify COVID-19 positive LCI patients, monitor them under physician supervision, and escalate care as needed with AH HAH program. Methods: AH Information Services created an automated list of LCI COVID-19 positive patients with a daily database. Each patient was reviewed by a nurse navigator. Review included hematologic or oncologic diagnosis, outpatient or inpatient status, and any COVID-19 symptoms. Once a malignant diagnosis was confirmed, a diagnosis-specific navigator contacted and screened the patient with a COVID assessment tool. Documentation was forwarded to the primary oncologist/hematologist. The tool scored patients for surveillance and treatment needs. A score of 0-2 prompted phone assessment every 48-72 hours, and score of 3-5 required every 24-48 hour calls with physician involvement when appropriate. If score of ≥6, care was escalated to LCI nurse/physician for admission to AH acute care HAH or conventional inpatient admission. Results: From inception on 3/20/2020 to data review date of 12/2/2020, 974 LCI patients were identified as COVID-19 positive and reviewed for nurse navigation (Table). Of the 974, 488 were navigated. Given limited resources, patients with benign conditions were not assigned a navigator, though a similar process was created for sickle cell disease. Of the 974, 75 are now deceased. Only 25 are deceased among the 488 navigated. Conclusions: The COVID-19 pandemic presented unprecedented circumstances to our patients and their clinicians. LCI expeditiously put policies and procedures in place to mitigate the intersection of COVID-19 and cancer. The multidisciplinary response strategy liaising between AH HAH and LCI followed, assessed, and assisted LCI COVID-19 positive patients. With our embedded nurse navigation team’s specialized attention along with enhanced physician oversight and close collaboration with AH HAH, opportunities for care escalation or adjustments in cancer-focused care were promptly identified. Analysis is ongoing to elucidate the lower mortality rate observed among navigated patients.[Table: see text]

Exploring Health-Related Needs of Elderly People (70+) at Home: A Qualitative Study From Switzerland

Background: The elderly represents the fastest growing group in our population. Since there is a close relationship between the number of older people and health care expenditure, promoting healthy aging has become an important topic. However, it is essential to understand first the needs of this population in order to create suitable programs and activities. Methods: A qualitative design was used in this study to explore the subjective views of elderly people and to learn more about their health-related needs. A total of 12 participants were recruited using a consecutive sampling strategy. The data were collected through semi-structured interviews and analyzed by employing a summarizing content analysis. Results: This study has identified 4 areas of health-related needs: Independence and autonomy, social security, structure in daily life and community and belonging, where all categories are interrelated and interact with one other. Conclusion: Focusing more on community-based approaches would support creating a conducive environment. Also, home visits undertaken by a specialized nurse focused on health risks and disabilities could be an adequate approach to support the elderly population in an efficient way and to offer targeted programs and activities.

Prevention and Reduction of Care Against Someone’s Will in Cognitively Impaired People at Home: A Feasibility Study

Sometimes care is provided to a cognitively impaired person against the person’s will, referred to as involuntary treatment. An intervention (PRITAH) was developed to prevent and reduce involuntary treatment comprising 4 components: client-centered care policy, workshops, coaching on the job by a specialized nurse and the use of alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.

Who are the ostomy patients and caregivers attending Portuguese community pharmacies? A cross-sectional study

Background In 2017, ostomy patients gained access to ostomy products in community pharmacies that are fully reimbursed by the Portuguese National Health Service. This impacted the daily lives of people with ostomy and opened a new market of products and services for pharmacies. However, little is known about the sociodemographic and clinical profile of ostomy patients. This study aims to characterize people with ostomy and their caregivers, evaluate access and satisfaction with the pharmacy and explore participants’ expectations regarding services and counselling. Methods This was an observational, cross-sectional, multicentre study involving pharmacy users who acquired ostomy products in Portuguese community pharmacies. Data were collected through a confidential self-report questionnaire between June and August 2019. Results Approximately 56% of the participants were ostomy patients, of whom 65.9% were men. The average age of participating ostomy patients was 65.5 years old (SD = 12.9), and near 80% were retired/pensioners. Caregivers were mostly women (81.7%). More than half of the caregivers were employed and acquired products for a direct family member. Three in every four surgical interventions were consequences of cancer. Intestinal ostomy was the most common intervention (78.3%). More than 93% were satisfied with the acquisition of ostomy products at the pharmacy. Approximately 48.2% of ostomy patients received care from a specialized nurse. Conclusion This study describes the profile of people with ostomy and their caregivers who attend community pharmacies in Portugal. Participants’ perceptions of the utility of different proposed services and pharmacist knowledge, as well as the low coverage of ostomy nursing care, highlight the opportunity for an extended role of pharmacists among this group.

What Was the Role of Nurses During the 2011 Great East Earthquake of Japan? An Integrative Review of the Japanese Literature

BackgroundAn earthquake and tsunami hit the east coast of Japan on March 11, 2011. Nurses were actively involved in the health response to this disaster and, subsequently, many authors have reported on the role nurses played in these efforts in Japanese nursing professional journals.AimTo describe the role of nurses who assisted in the 2011 Great East Earthquake of Japan by reviewing Japanese literature and reporting the findings in English.MethodThis research used an integrative literature review methodology. Manuscripts were obtained from the Japanese database Ichushi Ver. 5 (Japan Medical Abstracts Society, Tokyo, Japan). A total of 44 manuscripts were identified and included in a thematic analysis.ResultsThree main themes were identified: (1) nursing roles, (2) specialized nursing roles, and (3) preparedness education. Nurses fulfilled different roles in the period after the disaster (ie, as a clinician, a communicator, a leader, and a provider of psychosocial support). Additionally, the specialized nurse role was identified, along with the need for preparedness education to support the nurse's role in a disaster.ConclusionThe understanding of the role of nurses in disasters is expanding. There is a need to further explore the roles of specialized nurses in disasters. Further disaster education opportunities should be available as a part of continuing education for all nurses. Radiation aspects of disaster assistance should be included in disaster education programs where there are radio-nuclear hazards present in the environment.KakoM, RanseJ, YamamotoA, ArbonP. What was the role of nurses during the 2011 Great East Earthquake of Japan? An integrative review of the Japanese literature. Prehosp Disaster Med. 2014;29(3):1-5.

Are people with rheumatoid arthritis who undertake activity pacing at risk of being too physically inactive?

Objective: To gain insight into the relationship between activity pacing and physical inactivity. Design: A cross-sectional study. Setting: Outpatient clinic of a rheumatology department. Subjects: Men and women diagnosed with rheumatoid arthritis Main measures: Physical activity was assessed using self-reported measures and an accelerometer-based activity monitor. An occupational therapist and specialized nurse analysed the self-reported physical activity data and classified on the basis of consensus the pacing of activities of all patients as ‘adequate’ or ‘not adequate’. Results: Thirty rheumatoid arthritis patients participated in this study of whom nine were categorized as adequate activity pacers. None of these nine undertook sufficient exercise whereas 6 of the 20 people who did not pace activity appropriately did. Physical activity levels assessed by self-reported measures were significantly higher than when assessed by an accelerometer-based activity monitor. Conclusions: Activity pacing was associated with lower levels of physical activity. Since patients with rheumatoid arthritis are already at risk for inactivity, further inactivation by activity pacing might potentially be harmful.