背景:卫生保健机构实施了许多政策和程序(P&P)改革,以对抗2019年冠状病毒病(COVID-19)的传播。常见的变化包括增加个人防护设备的使用,房间入住限制,访客/家庭成员的限制和志愿者的缺席。这项研究评估了不列颠哥伦比亚省放射治疗师(RTs)关于COVID-19P&P变化如何影响其临床实践的当前观点和意见。目标是找出RT实践领域的差距,允许RTs之间的自我反思,并有可能通过以患者为中心的护理来指导未来的P&P。
方法:创建了24项横断面调查问卷,并通过电子邮件发送给全省所有工作的RTs。问卷中探讨的关键部分是:1)患者护理交付,2)员工工作环境,3)工作满意度。对问卷答复进行描述性分析。
结果:在大约300名受邀参与者中,从放射治疗的所有领域收到了107份答复(治疗单位,CT模拟,剂量测定,等。)和该省所有癌症中心。RT工作人员表示,COVID-19P&P对患者护理产生了负面影响,包括与患者进行口头和非口头交流的能力(82%),评估副作用(85%),并建立融洽的关系(62%)。大多数(79%)的RT员工认为与同事的沟通也受到了负面影响。当被问及对员工环境的影响时,51%的RT工作人员同意志愿者的缺席增加了他们的工作量,并且反应两极分化(46%的人不同意,35%的人同意)当被问及RT工作人员是否有足够的时间在新的COVID-19P&P到位的情况下清洁他们的临床区域时。78%的RT知道COVID-19安全问题的去向,并认为他们接受了关于COVIDP&P的充分教育。当被要求对影响RT实践的因素进行排名时,RTs发现PPE使用量增加(83%),没有志愿者(74%)和房间入住限制(70%),因为领先的P&P变化对他们的实践产生了负面影响;而有机玻璃屏障(39%),重新安排的工作空间(37%)和远程工作(12%)的负面影响最小。
结论:大多数BC癌症患者对问卷的回答表明,他们提供患者护理的能力和员工工作环境受到实施的COVID-19P&P的负面影响。关于COVID-19P&P培训/教育的意见是积极的,然而,对于改革是否顺利实施,没有达成共识。这项研究可以促进临床领导和RTs对将来如何实施P&P的反思,并可以鼓励进一步的回顾性分析,以帮助开发有关未来公共卫生暴发的P&P。
BACKGROUND: There were many policy and procedure (P&P) changes implemented in health care facilities to combat the spread of the coronavirus disease 2019 (COVID-19). Common changes included an increase in personal protective equipment usage, room occupancy limits, limitations in visitors/family members and the absence of volunteers. This study evaluated the current views and opinions of Radiation Therapists (RTs) in British Columbia relating to how COVID-19 P&P changes have impacted their clinical practice. The goal was to identify gaps in the areas of RT practice, allow for self-reflection among RTs and potentially guide future P&Ps with patient-centred care at the forefront.
METHODS: A 24-item cross-sectional questionnaire was created and sent via e-mail to all RTs working across the province. Key sections explored in the questionnaire were: 1) patient care delivery, 2) staff-work environment, and 3) work satisfaction. Descriptive analysis was performed on the questionnaire responses.
RESULTS: Of the approximate 300 invited participants, 107 responses were received from all areas of Radiation Therapy (Treatment units, CT simulation, Dosimetry, etc.) and from all cancer centres in the province. RT staff indicated that COVID-19 P&P negatively impacted patient care, including the ability to verbally and non-verbally communicate with patients (82 %), assess for side effects (85 %), and build rapport (62 %). A majority (79 %) of RT staff felt that communication with co-workers had been negatively impacted as well. When queried regarding the impact on staff environment, 51 % of RT staff agreed that the absence of volunteers increased their workload and the responses were polarized (46 % disagree, 35 % agree) when asked if RT staff have enough time for cleaning their clinical areas with new COVID-19 P&Ps in place. 78 % of RTs were aware of where to go with COVID-19 safety concerns and thought they received adequate education concerning COVID P&Ps. When asked to rank the factors that most impacted RT practice, RTs identified increased PPE usage (83 %), absence of volunteers (74 %), and room occupancy limits (70 %) as the leading P&P changes that negatively impacted their practice; while plexiglass barriers (39 %), re-arranged workspaces (37 %) and working remotely (12 %) were the least negatively impactful.
CONCLUSIONS: The majority of RTs across BC Cancer responding to the questionnaire indicated that their ability to provide patient care and their staff-work environment were negatively impacted by implemented COVID-19 P&Ps. Views regarding COVID-19 P&P training/education was positive, yet there was no consensus regarding whether the changes were implemented smoothly. This study can facilitate reflection among both clinical leadership and RTs on how P&Ps can be implemented in the future and can encourage further retrospective analyses in aiding the development of P&Ps regarding future public health outbreaks.