Nurses in isolation, and the dark clouds and silver linings revealed by COVID-19

In a special feature, Helen Cowan interviews two nurses who are shielding during COVID-19 to gain an insight into their experiences of isolation during the lockdown when their colleagues are out on the frontline. She also shares her own experiences and insights as a care home nurse shielding during the current pandemic.

A Qualitative Study of Increased Pediatric Reutilization After a Postdischarge Home Nurse Visit

BACKGROUND: The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. We sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions. METHODS: We sought qualitative input using focus groups and interviews from stakeholder groups: parents, primary care physicians (PCP), hospital medicine physicians, and home care registered nurses (RNs). A multidisciplinary team coded and analyzed transcripts using an inductive, iterative approach. RESULTS: Thirty-three parents participated in interviews. Three focus groups were completed with PCPs (n = 7), 2 with hospital medicine physicians (n = 12), and 2 with RNs (n = 10). Major themes in the explanation of increased reutilization included: appropriateness of patient reutilization; impact of red flags/warning sign instructions on family’s reutilization decisions; hospital-affiliated RNs “directing traffic” back to hospital; and home visit RNs had a low threshold for escalating care. Major themes for improving design of the intervention included: need for improved postdischarge communication; individualizing home visits—one size does not fit all; and providing context and framing of red flags. CONCLUSION: Stakeholders questioned whether hospital reutilization was appropriate and whether the intervention unintentionally directed patients back to the hospital. Future interventions could individualize the visit to specific needs or diagnoses, enhance postdischarge communication, and better connect patients and home nurses to primary care.

Opposing orientations in interactions with individuals with Frontotemporal Dementia

Clinically, frontotemporal dementia (FTD) is described as primarily affecting personality and interpersonal conduct and resulting in social behavioral disruptions, thus often giving rise to interpersonal conflict. Conflict behavior in both typical and dementia populations is frequently identified as explicit physical and verbal acts such as assault, yelling or insulting, and research often situates conflict and collaboration as opposing dimensions. The premise of this article is to examine the unfolding of moments in which individuals diagnosed with FTD and their carers demonstrate opposing orientations towards an activity in real time interaction: A home nurse needing to fulfill an institutional agenda — taking sitting blood pressure — seeks the cooperation from an individual who, in attempting to lie down, interferes with this agenda. These moments constitute sources of interactional conflict that carers attempt to resolve. However, often conflict behavior and cooperative behavior are not neatly teased apart; for instance, individuals often display conflicting orientations towards an overarching or guiding activity while cooperating in more immediate and discrete interactional tasks. These verbal/nonverbal conflicts are not large acts of aggression; rather, they may be viewed as arising within the mundane moments of life that individuals face in everyday contexts and frequently.