#WeDNs - Wednesday 2nd December 2020 8pm (GMT Standard Time)
Journal Club 2: Accessing Evidence during a Pandemic
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Hosted by WeCommNurses using #WeDNs
This chat is guest hosted by @mdrumm88
For our second Journal Club we are going to have a tweet chat on a rapid review related to palliative care, community nursing and the covid-19 pandemic. Journal clubs are an easy way to engage with published literature in a relaxed and informal way. Participating in a journal club supports evidence-based practice, increases confidence in accessing research and contributes to revalidation/portfolio hours. There is no obligation to read the article before the chat but being familiar with it will improve our discussion.
For this Journal Club we are going to take our discussion wider than the literature review and use it as an opportunity to reflect on the covid-19 pandemic and consider how we are feeling moving forward into winter.
URL: https://www.cebm.net/covid-19/primary-carw-and-community-nursing/
The research question that this rapid review aimed to address: What is the role and response of primary care and community nursing services in the delivery of palliative care in epidemics and pandemics?
Questions to Consider
- What are your impressions of the review? You might want to consider the “rapid” approach and why this was selected over other types of literature reviews, such as systematic reviews.
- What did you think about the findings?
- What did you think about the conclusions?
- Do you think the findings of this review are still current and up to date five months later?
- Have you felt able to keep up with emerging literature related to palliative and end of life care in the community during the pandemic? If so, what resources have you relied on?
- How do you process the changes to clinical practice that have been implemented since March 2020? Is there anyone you speak to or debrief with? Any helpful services?
- How do you feel as we head into the winter?
- How do you unwind and switch off?
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#WeDNs transcript
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@WeCommNurses
02 December 2020 20:00
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Welcome to Journal Club 2! Over the next hour we'll be discussing a rapid review by @CebmOxford If you haven't read the paper you'll find it at https://www.cebm.net/covid-19/primary-carw-and-community-nursing/ Don't forget to use the hashtag #wedns on all your contributory tweets! |
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@AFTaylorDN
02 December 2020 20:01
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Hello #WeDNs Looking forward to Journal Club tonight. https://twitter.com/WeDistrictNurse/status/1334225832752148481 |
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@WeCommNurses
02 December 2020 20:02
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It's @mdrumm88 tweeting from the #weDNs account. I hope you enjoy our discussion. Who do we have joining us this evening? Anyone's first tweet chat? |
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@mdrumm88
02 December 2020 20:02
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RT @WeDistrictNurse: It's @mdrumm88 tweeting from the #weDNs account. I hope you enjoy our discussion. Who do we have joining us this eveni… |
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@WeCommNurses
02 December 2020 20:04
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Question 1: What were your overall impressions of the paper? Do you think the background section made a good case for the need for a review? #wedns |
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@HeatherBain9
02 December 2020 20:04
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#weDNs, looking forward to the discussion https://twitter.com/wedistrictnurse/status/1334226377541787648 |
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@WeCommNurses
02 December 2020 20:04
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@SusanWainwrig14 @mdrumm88 Hi Suzy - welcome #WeDNs |
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@AFTaylorDN
02 December 2020 20:06
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@WeDistrictNurse The case was made but the authorship was GP-centric (no community nurse) and that is reflected in the content I think #WeDNs |
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@WeCommNurses
02 December 2020 20:07
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I thought the authors gave a clear explanation for their research question. But I was a bit disappointed that they seemed to lump all community nursing services into one homogenous group. Yet used district nursing as one of their search terms? #wedns |
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@SusanWainwrig14
02 December 2020 20:08
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@WeDistrictNurse I agree it was GP-centric, but acknowledged the lack of evidence in community services as part of a pandemic response. #weDNs |
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@AFTaylorDN
02 December 2020 20:09
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@WeDistrictNurse Definately - this may come later but they were muddled throughout in their terminology for anyone other than the GP. At one point they seemed to refer to healthcare workers, slide into care homes & out again, referred to 'Primary care' without clarifying terms etc #WeDNs |
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@WeCommNurses
02 December 2020 20:10
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Interesting points here. I wonder if peer-review would have addressed these issues? #wedns https://twitter.com/AFTaylorDN/status/1334228254056648712 |
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@SusanWainwrig14
02 December 2020 20:11
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@WeDistrictNurse Most of the research was not UK based to be fair. So the titles may differ country to country. #weDNs |
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@WeCommNurses
02 December 2020 20:12
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RT @SusanWainwrig14: @WeDistrictNurse Most of the research was not UK based to be fair. So the titles may differ country to country. #weDNs |
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@AFTaylorDN
02 December 2020 20:12
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@WeDistrictNurse Yes, or even having a nurse on the research team.... It is a depressing reality that community nursing is still so poorly understood and defined, even with our GP colleagues #WeDNs |
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@AFTaylorDN
02 December 2020 20:13
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@SusanWainwrig14 @WeDistrictNurse True Suzy - good point, but then definitions should have been made to clarify #WeDNs |
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@WeCommNurses
02 December 2020 20:14
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@AFTaylorDN We need more research to evidence our worth and contribution but with no time available to participate or advise how will that happen? #wedns |
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@AFTaylorDN
02 December 2020 20:14
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@SusanWainwrig14 @WeDistrictNurse Again I agree but their level of surprise was a surprise to me as we know so well how little research there is into community nursing practice across all disciplines & activities #WeDNs |
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@WeCommNurses
02 December 2020 20:15
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Question 2: What were your thoughts on the findings section and the use of the Systems, Space, Staff, Stuff model to organise and present the findings? #weDNs |
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@AFTaylorDN
02 December 2020 20:15
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This is the question #WeDNs ! https://twitter.com/WeDistrictNurse/status/1334229459298349059 |
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@WeCommNurses
02 December 2020 20:17
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For anyone interested, this is a link to the paper that the authors used to format their findings: https://pubmed.ncbi.nlm.nih.gov/20152591/ #wedns |
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@AFTaylorDN
02 December 2020 20:18
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@WeDistrictNurse Again a bit muddled: 'Space' was care at home but they referred to care homes...which is someone's home of course, 'Staff' was all about Primary care (not community) and it was generally thin - perhaps because of the paucity of research? Not a model I've come across before #WeDNs |
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@SusanWainwrig14
02 December 2020 20:19
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@WeDistrictNurse Not as nuanced as it could have been, but as a general structure for presenting conclusions it's clear at least. #weDNs |
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@AFTaylorDN
02 December 2020 20:19
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@WeDistrictNurse That's helpful, thank you #WeDNs |
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@WeCommNurses
02 December 2020 20:20
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@AFTaylorDN I liked it but I think that's because I like the paper they adopted it from. It was written over 10 years ago and was a call to action for palliative care pandemic plans, yet was ignored. #wedns |
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@AFTaylorDN
02 December 2020 20:20
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@SusanWainwrig14 @WeDistrictNurse Yes, it did at least give a framework of sorts #WeDNs |
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@WeCommNurses
02 December 2020 20:22
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@SusanWainwrig14 I wonder how we would feel about it with more evidence included? #wedns |
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@AFTaylorDN
02 December 2020 20:23
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@WeDistrictNurse Interesting - do you think this influenced your view? #WeDNs |
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@SusanWainwrig14
02 December 2020 20:23
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@AFTaylorDN @WeDistrictNurse I think the conclusions were a bit limited, rather than the model. ?? #weDNs |
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@WeCommNurses
02 December 2020 20:24
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Question 3: What did you think of the conclusions? #wedns |
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@AFTaylorDN
02 December 2020 20:25
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@WeDistrictNurse Really a bit obvious.... #ICouldHaveToldYouThat....or am I being unfair? #WeDNs |
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@SusanWainwrig14
02 December 2020 20:26
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@WeDistrictNurse I think that was the issue, they only had about 21 articles and 5 studies to reference that met the criteria. #weDNs |
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@WeCommNurses
02 December 2020 20:26
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@AFTaylorDN I agree. But what can you conclude with hardly any evidence? Other than the obvious! #wedns |
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@AFTaylorDN
02 December 2020 20:27
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@WeDistrictNurse Yes, that's true #WeDNs...I was being unfair?? |
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@HeatherBain9
02 December 2020 20:29
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#weDNs It is the synthesis of the included papers that is more important than the number of papers. https://twitter.com/SusanWainwrig14/status/1334232597631799299 |
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@WeCommNurses
02 December 2020 20:29
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Question 4: Do you think the review is still up to date six months later? #wedns |
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@WeCommNurses
02 December 2020 20:30
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RT @HeatherBain9: #weDNs It is the synthesis of the included papers that is more important than the number of papers. https://t.co/Ni0sla0H… |
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@SusanWainwrig14
02 December 2020 20:31
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@WeDistrictNurse Well, in this country we haven't had a pandemic like this to learn from. But as part of pandemic planning the nursing services should have played a role. Nurses were the lynchpin of the response to AIDS and Ebola in Africa. We should have learned from them. #weDNs |
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@AFTaylorDN
02 December 2020 20:31
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@WeDistrictNurse Well the conclusion that we need more research stands...#WeDNs |
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@WeCommNurses
02 December 2020 20:33
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@AFTaylorDN That's usually a safe-bet conclusion ?? #wedns |
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@AFTaylorDN
02 December 2020 20:33
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@HeatherBain9 @WeDistrictNurse I’m afraid I found the synthesis about as thin as the evidence. Partly I think because the definitions & understanding of community nursing practice was so poor. Maybe a GP would have found it more accurate for their practice? #WeDNs |
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@AFTaylorDN
02 December 2020 20:34
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@WeDistrictNurse Laugh or we'd cry.... #WeDNs |
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@WeCommNurses
02 December 2020 20:34
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@AFTaylorDN @HeatherBain9 I wondered this too, it would be interesting to find out what a GP thinks of it. #wedns |
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@HeatherBain9
02 December 2020 20:36
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@AFTaylorDN @WeDistrictNurse #weDNs my comment was generic not applied to this paper |
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@AFTaylorDN
02 December 2020 20:37
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@WeDistrictNurse @HeatherBain9 Shall we ask @Trisha_the_doc (works in community medicine I think?) or @pkonline84 or @trishgreenhalgh ? #WeDNs |
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@AFTaylorDN
02 December 2020 20:37
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@HeatherBain9 @WeDistrictNurse Good point though #WeDNs |
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@WeCommNurses
02 December 2020 20:37
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Question 5: How do we balance the need for speedy evidence to inform guidelines and practice with the need for robust research and processes? #weDNs |
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@WeCommNurses
02 December 2020 20:38
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@AFTaylorDN @HeatherBain9 @Trisha_the_doc @pkonline84 @trishgreenhalgh Great idea! #wedns |
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@WeCommNurses
02 December 2020 20:40
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This is something I struggled with during the first half of the pandemic. I think speed was prioritised over quality in some of the early published research. #wedns |
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@AFTaylorDN
02 December 2020 20:41
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@WeDistrictNurse There are a few things here - new circumstances/crises mean you have to do the best you can with the rationale you have at the time & be ready to apply learning but question to academia if we can have rapid access to research teams in a crisis? #WeDNs |
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@SusanWainwrig14
02 December 2020 20:42
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@AFTaylorDN @HeatherBain9 @WeDistrictNurse Of the referenced articles I saw one that seemed most relevant to community nurses, a joint US S. Africa study on community health workers. #weDNs |
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@WeCommNurses
02 December 2020 20:42
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Also, the experiences of community nurses and nurses in general were totally overlooked in the early research. I think because most nurses are women and we were/are busy in work and with extra caring responsibilities? #wedns |
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@AFTaylorDN
02 December 2020 20:43
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@WeDistrictNurse A necessary evil? Important to keep an open mind in such fast-moving practice landscape #WeDNs |
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@WeCommNurses
02 December 2020 20:45
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@AFTaylorDN Absolutely and hopefully with our research knowledge we have the necessary appraisal skills to make informed judgements? #wedns |
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@AFTaylorDN
02 December 2020 20:45
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@WeDistrictNurse I think this is more to do with money. We don't commission - but are commissioned so can be invisible in the policy world. For example, our vaccination work is hidden as GPs purchase the flu vac & we administer. I think. #WeDNs |
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@AFTaylorDN
02 December 2020 20:46
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@WeDistrictNurse That's an essential skill for nursing practice #WeDNs @nmcnews |
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@WeCommNurses
02 December 2020 20:46
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RT @AFTaylorDN: @WeDistrictNurse That's an essential skill for nursing practice #WeDNs @nmcnews |
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@WeCommNurses
02 December 2020 20:47
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Question 6: What have been the most reliable resources you have used during the pandemic to inform palliative and end of life care? #wedns |
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@AFTaylorDN
02 December 2020 20:47
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@SusanWainwrig14 @WeDistrictNurse @HeatherBain9 Good point - and that is a different context so how transferrable are the results? #WeDNs |
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@SusanWainwrig14
02 December 2020 20:48
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@WeDistrictNurse We struggled with this too. Covid presents very differently. The rapidity of the deterioration was almost impossible to manage. The services were just too slow. In an hour things change rapidly. #weDNs |
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@SusanWainwrig14
02 December 2020 20:52
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@WeDistrictNurse The guidelines we use were not even reviewed so we and our CNS's were just going situation to situation. Experience could have been shared so best practice could be identified sooner. #weDNs |
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@WeCommNurses
02 December 2020 20:52
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I have relied on the updated Scottish Palliative Care guidelines #wedns https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom-control/end-of-life-care-guidance-when-a-person-is-imminently-dying-from-covid-19-lung-disease.aspx |
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@WeCommNurses
02 December 2020 20:53
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@SusanWainwrig14 Did you have mechanisms in place to share experiences? #wedns |
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@AFTaylorDN
02 December 2020 20:53
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RT @WeDistrictNurse: I have relied on the updated Scottish Palliative Care guidelines #wedns https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom-control/end-of-life-care-guidance-when-a-person-is-imminently-dying-from-covid-19-lung-disease.aspx |
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@WeCommNurses
02 December 2020 20:54
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Question 7: One of the findings of this review relates to the importance of debriefing to allow us to talk about the impact of dealing with so much death, loss, moral distress, and limited resources. Have you debriefed? If so, with who? #wedns |
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@SamSherrington
02 December 2020 20:54
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@WeDistrictNurse I’ve joined the palliative care webinars led by @SherreeFagge that were held weekly, great ideas, information on guidance, best practices - brilliant resources @PhilBrough #weDNs |
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@WeCommNurses
02 December 2020 20:56
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@SusanWainwrig14 Absolutely. #wedns |
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@AFTaylorDN
02 December 2020 20:57
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@WeDistrictNurse @ParishNursingUK Parish Nurses have clinical supervision with us and many also find their own spiritual supervision in addition #WeDNs #invaluable |
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@SamSherrington
02 December 2020 20:57
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@WeDistrictNurse It was wonderful to hear about @locala approach led by chief nurse @JulieClennell and team, managing group clinical supervision for teams dealing with end of life. Great egs of best practice on @TheQNI website too #weDNs |
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@WeCommNurses
02 December 2020 20:59
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Working in out of hours we have no opportunity to debrief but it is badly needed! Where would the time come from? #wedns |
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@WeCommNurses
02 December 2020 21:00
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Well that's time up! Thanks everyone for such an interesting discussion. I hope you all found it useful. Please get in touch with @mdrumm88 if you have any ideas for future journal clubs. #WeDNs https://t.co/HVVII6EcPd |
Stats
Total contributers:
6
Total tweets:
71
Total reach:
447,328
