Background: The COVID-19 pandemic challenges multiple sclerosis services to be innovative in delivering infusible therapies. To reduce time in clinical settings, and potential staff or space losses, we implemented rapid infusion protocols for selected patients. Objective: To analyse the rate of infusion related reactions and patient experience of rapid infusions of natalizumab and ocrelizumab. To document time reduction patients spent in clinical settings during the COVID-19 pandemic. Methods: Patients with prior exposure to at least three natalizumab or two 300mg ocrelizumab infusions were approved for rapid protocols. A retrospective audit and survey were completed. Results: We analysed 269 rapid natalizumab infusions and 100 rapid ocrelizumab infusions. Infusion related reactions during the natalizumab or ocrelizumab infusions occurred in two patients (1.52%) and eight patients (8%), respectively. All infusion related reactions were mild to moderate and did not require infusion discontinuation. No infusion reactions occurred during the post-infusion observation. Patient experience was positive. Conclusion: Frequency or severity of infusion related reactions in rapid infusions were no different compared to published data. In the setting of COVID-19, pandemic rapid infusion protocols could potentially save hospital resources and limit patient exposure to a high-risk clinical setting while still maintaining ongoing treatment of multiple sclerosis.
Mental health nursing work is challenging, and workplace stress can have negative impacts on nurses' well‐being and practice. Resilience is a dynamic process of positive adaptation and recovery from adversity. The aims of this integrative review were to examine and update understandings and perspectives on resilience in mental health nursing research, and to explore and synthesize the state of empirical knowledge on mental health nurse resilience. This is an update of evidence from a previous review published in 2019. Using integrative review methodology, 15 articles were identified from a systematic search (July 2018–June 2022). Data were extracted, analysed with constant comparison method, synthesized narratively and then compared with the findings from the original review. As an update of evidence, mental health nurse resilience was moderate to high across studies, was positively associated with psychological well‐being, post‐traumatic growth, compassion satisfaction and negatively associated with burnout, mental distress and emotional labour. Lack of support and resources from organizations could negatively impact nurses' ability to maintain resilience and manage workplace challenges through internal self‐regulatory processes. A resilience programme improved mental health nurses' awareness of personal resilience levels, self‐confidence, capacity to develop coping skills and professional relationships. Some studies continue to lack contemporary conceptualizations of resilience, and methodological quality varied from high to low. Further qualitative and interventional research is needed to investigate the role of resilience in mental health nursing practice, personal well‐being, workforce sustainability and the ongoing impacts of the COVID‐19 pandemic.
Mental health nurses are exposed frequently to occupational stress and can experience a range of negative impacts on their well-being and intention to stay in the nursing workforce. Promoting Resilience in Nurses (PRiN) is a strength-based resilience education programme that incorporates evidence-based cognitive behavioural and interpersonal approaches with post-traumatic growth theory. A partially clustered randomized controlled trial at a large public mental health service will be used to examine the effects of PRiN on mental health nurses' coping self-efficacy, resilience, well-being, mental health, emotional regulation, post-traumatic growth, workplace belonging, and turnover intention as compared to controls. Process evaluations are increasingly used to help understand and interpret trial results for complex interventions. This paper describes the protocol for an embedded mixed methods process evaluation that aims to evaluate the PRiN programme implementation and identify factors that may explain variation in participant outcomes in the trial. Data collection includes a programme participant satisfaction survey; a follow-up semi-structured interview with selected programme participants; a unit/team manager survey on barriers and facilitators to staff recruitment and programme participation; and a fidelity checklist completed by programme facilitators. Normalisation Process Theory will be used to inform data analysis and integration. The findings will provide insights into factors that affect programme implementation, particularly in the context of the COVID-19 pandemic and may help explain differences in participant outcomes. Findings will also inform post-trial programme sustainability as well as potential future upscale and adaptation for implementation across healthcare settings.
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