BackgroundCystic Fibrosis (CF) infectious isolation guidelines and clinical recommendations exist in standards of CF care to reduce the risk of cross-infection between individuals with CF. Chronic infection is associated with deterioration in lung function and increased rates of morbidity and mortality, thus preventing and reducing cross-infection is a concern for individuals with CF. Understanding the bio-psychosocial implications of isolation is vital to developing and providing holistic approaches to CF care. This study aimed to make sense of how adolescents with CF understand and experience infectious isolation during their care. MethodQualitative, semi-structured interviews were conducted with nine adolescents, aged 12-19 years-old, with a diagnosis of CF who had experienced isolation. Interviews were analyzed using inductive thematic analysis. ADOLESCENTS' EXPERIENCES OF ISOLATION IN CYSTIC FIBROSIS 2 ResultsParticipants experienced difficulty adjusting to living with isolation and attempted to integrate their isolation experiences. Isolation highlighted a sense of threat posed by crossinfection, a threat which participants experienced as originating from others and from themselves to others. Participants described striving to protect themselves and others from this threat. Isolation also appeared to exacerbate differences participants noticed between themselves and others without CF. ConclusionFor adolescents with CF, isolation is not a neutral experience. Adolescents reported difficulty understanding isolation and challenges associated with this experience across settings. Given these difficulties, multi-disciplinary teams should increase awareness, understanding and discussion about the psychosocial impact of isolation amongst those with CF, their families and wider systems, to promote optimal bio-psychosocial outcomes. Future research could explore experiences of isolation from children, family and staff perspectives.
The pandemic has resulted in an unprecedented amount of attention being given to the psychological wellbeing of healthcare staff. But the role of psychological interventions has been controversial, particularly in the context of psychological debriefing. This paper sets out the reflections of a group of psychologists involved in delivering these interventions for many years together with suggestions for how we move forward.
Aims Paediatrics is one of the most diverse and rewarding fields of medicine but also brings with it unique medical and ethical challenges. We also care for increasingly complex medical patients and are faced with ethical dilemmas that can lead to conflict with families and a challenging work environment: it can be emotionally exhausting. At our tertiary children's hospital we became aware that this was having a negative impact on our staff 's wellbeing and ability to care for our patients. In particular we recognised that staff were being exposed to distressing events and then expected to continue with clinical work with no formal system to debrief or acknowledge the impact of these events. We aimed to do something to address this. Methods We established a working group of senior nurses, executive members, Paediatricians and Psychologists to identify issues and implement change through our SuPPORT programme. Within this, we created a staff support psychologist (PSS) role (0.3 WTE) to establish a psychological debrief pathway, coordinate and run debriefs and establish/scope other supports e.g. reflective practice. Results The group has created a staff support 'pyramid', developing new resources and bringing together activities which were already in place. This includes a robust debrief pathway following serious incidents, and Paediatric Schwartz rounds. The PSS role has been central in this process. Since the role began we have run regular reflective practice sessions in several areas, and held 71 psychology mediated debriefs. Feedback from staff has been hugely positive. Conclusion By establishing this programme we have acknowledged that staff may feel overwhelmed by the complex medical and ethical situations in paediatric care. We are still in the early stages, but staff report feeling a different 'culture' of support at work. Crucial to this has been the commitment by our senior leadership team. We recognise that these problems are not unique to our hospital and have had interest from other hospitals in spreading this model.
Data in second audit period, before the fluid prescription power plan had been implemented, showed that 51% of IV maintenance fluids were isotonic. This increased to 88%, after the power plan was introduced. Across both the second and third audit periods, there were 2 infants who developed hyponatraemia after receiving maintenance IV fluids. One was on a mixture of TPN and isotonic fluid, the other was on hypotonic fluids. There was only one incident of hypernatraemia (146), which occurred while on 10% dextrose infusion. Conclusion The prescription of isotonic solutions has increased significantly since the EPR power plan for paediatric fluid prescriptions was introduced. This had a much greater impact than trying to encourage guideline adherence alone. There is little published evidence on the safety of isotonic fluids in young infants. We have not observed any significant hypernatraemia since the increase in isotonic fluid usage.
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