Sasha Lewis-Jackson - Academia.edu (original) (raw)

Papers by Sasha Lewis-Jackson

Research paper thumbnail of Perceptions of government guidance and citizen responses during the COVID-19 pandemic: A cross-country analysis

SSM - Qualitative Research in Health

Research paper thumbnail of What are the priority needs for those caring for children and young people with complex neurodisability within an ethnically diverse UK context? - The feasibility phase of the ENCOMPASS study

BackgroundChildren and young people (CYP) with complex neurodisability experience multiple physic... more BackgroundChildren and young people (CYP) with complex neurodisability experience multiple physical, communication, educational and social challenges which require complex packages of multidisciplinary care. Cerebral palsy, an exemplar complex neurodisability condition, is the most common cause of serious physical disabilities among children globally. It is unclear the best way to meet the emotional, social, practical, and empowerment needs of CYP with complex neurodisability and their caregivers. The aim of this study was to determine the needs and priorities of those caring for CYP with complex neurodisability. This forms part of the feasibility phase of a wider study (ENCOMPASS) which aims to adapt the ‘Baby Ubuntu’ intervention, a participatory caregiver programme for families of CYP with complex neurodisability, to an ethnically diverse urban UK context.MethodsTwo rounds of semi-structured interviews were conducted with 12 caregivers of CYP with complex neurodisability and six ...

Research paper thumbnail of Policies and Politics: An Analysis of Public Policies Aimed at the Reorganisation of Healthcare Delivery During the COVID-19 Pandemic

Caring on the Frontline during COVID-19, 2022

Lewis-Jackson, Sasha, Eleonora Iob, Valentina Giunchiglia, Jose Roberto Cabral, Maria Romeu-Labay... more Lewis-Jackson, Sasha, Eleonora Iob, Valentina Giunchiglia, Jose Roberto Cabral, Maria Romeu-Labayen, Silvie Cooper, Rirhandzu Makamu, et al. 2022. "Policies and Politics: An Analysis of Public Policies Aimed at the Reorganisation of Healthcare Delivery During the COVID-19 Pandemic." In Caring on the Frontline during COVID-19: Contributions from Rapid Qualitative Research, edited by Cecilia Vindrola-Padros and Ginger A. Johnson, 39-64. Singapore: Springer Singapore.

Research paper thumbnail of sj-docx-1-pmj-10.1177_02692163211004228 – Supplemental material for Missing the human connection: A rapid appraisal of healthcare workers' perceptions and experiences of providing palliative care during the COVID-19 pandemic

Supplemental material, sj-docx-1-pmj-10.1177_02692163211004228 for Missing the human connection: ... more Supplemental material, sj-docx-1-pmj-10.1177_02692163211004228 for Missing the human connection: A rapid appraisal of healthcare workers' perceptions and experiences of providing palliative care during the COVID-19 pandemic by Lucy Mitchinson, Anna Dowrick, Caroline Buck, Katarina Hoernke, Sam Martin, Samantha Vanderslott, Hannah Robinson, Felicia Rankl, Louisa Manby, Sasha Lewis-Jackson and Cecilia Vindrola-Padros in Palliative Medicine

Research paper thumbnail of Missing the human connection: A rapid appraisal of healthcare workers’ perceptions and experiences of providing palliative care during the COVID-19 pandemic

Palliative Medicine, 2021

Background: During infectious epidemics, healthcare workers are required to deliver traditional c... more Background: During infectious epidemics, healthcare workers are required to deliver traditional care while facing new pressures. Time and resource restrictions, a focus on saving lives and new safety measures can lead to traditional aspects of care delivery being neglected. Aim: Identify barriers to delivering end-of-life care, describe attempts to deliver care during the COVID-19 pandemic, and understand the impact this had on staff. Design: A rapid appraisal was conducted incorporating a rapid review of policies from the United Kingdom, semi-structured telephone interviews with healthcare workers, and a review of mass print media news stories and social media posts describing healthcare worker’s experiences of delivering care during the pandemic. Data were coded and analysed using framework analysis. Setting/Participants: From a larger ongoing study, 22 interviews which mentioned death or caring for patients at end-of-life, eight government and National Health Service policies aff...

Research paper thumbnail of Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK

BMJ Open, 2020

ObjectiveThe COVID-19 pandemic has set unprecedented demand on the healthcare workforce around th... more ObjectiveThe COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK.MethodsThe study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) in-depth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis.ResultsLimited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work....

Research paper thumbnail of UK Health Care Workers’ Experiences of Major System Change in Elective Surgery during the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

BackgroundThe COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majorit... more BackgroundThe COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the UK, with the aim of developing lessons for future major systems change.MethodsUsing a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. We also carried out a policy review of the guidance developed for those delivering surgical services in pandemic conditions. We used framework analysis to organise and interpret findings.ResultsStaff discussed positive and negative experiences of rapid service organisation. Clinician-led decision making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positiv...

Research paper thumbnail of Frontline healthcare workers’ experiences with personal protective equipment during the COVID-19 pandemic in the UK: a rapid qualitative appraisal

BMJ Open, 2021

ObjectivesTo report frontline healthcare workers’ (HCWs) experiences with personal protective equ... more ObjectivesTo report frontline healthcare workers’ (HCWs) experiences with personal protective equipment (PPE) during the COVID-19 pandemic in the UK. To understand HCWs’ fears and concerns surrounding PPE, their experiences following its guidance and how these affected their perceived ability to deliver care during the COVID-19 pandemic.DesignA rapid qualitative appraisal study combining three sources of data: semistructured in-depth telephone interviews with frontline HCWs (n=46), media reports (n=39 newspaper articles and 145 000 social media posts) and government PPE policies (n=25).ParticipantsInterview participants were HCWs purposively sampled from critical care, emergency and respiratory departments as well as redeployed HCWs from primary, secondary and tertiary care centres across the UK.ResultsA major concern was running out of PPE, putting HCWs and patients at risk of infection. Following national level guidance was often not feasible when there were shortages, leading to ...

Research paper thumbnail of Healthcare workers’ perceptions and attitudes towards the UK’s COVID-19 vaccination programme

ObjectivesTo explore healthcare workers’ (HCWs) perceptions and attitudes towards the COVID-19 va... more ObjectivesTo explore healthcare workers’ (HCWs) perceptions and attitudes towards the COVID-19 vaccination programme in the UK, including their expectations, concerns and views on whether to promote vaccination to others. To understand the key factors shaping HCWs’ attitudes towards COVID-19 vaccination in the UK.DesignThis study was designed as a rapid qualitative appraisal integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semi-structured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis.ParticipantsInterviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies and guidelines on the vaccination programme were reviewed.ResultsThe level of uncertainty about the vaccines’ long-term safety and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HC...

Research paper thumbnail of Healthcare workers' perceptions and attitudes towards the UK's COVID-19 vaccination programme: a rapid qualitative appraisal

BMJ Open, 2022

Objectives: While there is research relating to perceptions of vaccines among healthcare workers ... more Objectives: While there is research relating to perceptions of vaccines among healthcare workers (HCWs), the evidence base in relation to COVID-19 remains limited. The aim of this study was to explore HCWs’ perceptions and attitudes towards vaccines and the COVID-19 vaccination programme in the UK, including their expectations and views on promoting vaccination to others.

Design: This study was designed as a rapid qualitative appraisal, integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semistructured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis.

Participants: Interviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies, and guidelines on the vaccination programme were reviewed.

Results: The level of uncertainty about the long-term safety of vaccines and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HCWs felt that government decisions on vaccine rollout had not been supported by evidence-based science, and this impacted their level of trust and confidence in the programme. The spread of misinformation online also impacted HCWs’ attitudes towards vaccination, particularly among junior level and black, Asian and minority ethnic (BAME) HCWs. Most HCWs felt encouraged to promote vaccination to their patients, and the majority said they would advocate vaccination or engage in conversations about vaccination with others when relevant.

Conclusion: In order to improve HCWs’ trust and confidence in the UK’s COVID-19 vaccination programme, there needs to be clarity about what is known and not known about the vaccines and transparency around the evidence-base supporting government decisions on vaccine rollout. Effort is also needed to dispel the spread of vaccine-related misinformation online and to address specific concerns, particularly among BAME and junior-level HCWs.

Research paper thumbnail of Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK

BMJ, 2020

Objective The COVID-19 pandemic has set unprecedented demand on the healthcare workforce around t... more Objective The COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK. Methods The study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) indepth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis. Results Limited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work. Lack of training for redeployed staff and the failure to consider the skills of redeployed staff for new areas were identified as problems. Positive aspects of daily work reported by HCWs included solidarity between colleagues, the establishment of well-being support structures and feeling valued by society. Conclusion Our study highlighted the importance of taking into consideration the experiences and concerns of front-line staff during a pandemic. Staff working in the UK during the COVID-19 pandemic advocated clear and consistent guidelines, streamlined testing of HCWs, administration of PPE and acknowledgement of the effects of PPE on routine practice.

Research paper thumbnail of Healthcare workers' perceptions and attitudes towards the UK's COVID-19 vaccination programme

British Medical Journal, 2021

Objectives To explore healthcare workers' (HCWs) perceptions and attitudes towards the COVID-19 v... more Objectives To explore healthcare workers' (HCWs) perceptions and attitudes towards the COVID-19 vaccination programme in the UK, including their expectations, concerns and views on whether to promote vaccination to others. To understand the key factors shaping HCWs' attitudes towards COVID-19 vaccination in the UK. Design This study was designed as a rapid qualitative appraisal integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semi-structured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis. Participants Interviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies and guidelines on the vaccination programme were reviewed. Results The level of uncertainty about the vaccines' long-term safety and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HCWs felt that government decisions on vaccine rollout had not been supported by evidence-based science and this impacted their level of trust and confidence in the programme. The spread of misinformation online also impacted HCWs' attitudes towards vaccination, particularly among junior level and Black, Asian and Minority Ethnic (BAME) HCWs. Most HCWs felt encouraged to promote vaccination to their patients and the majority said they would advocate vaccination or engage in conversations about vaccination with others when relevant. Conclusion In order to improve HCWs' trust and confidence in the UK's COVID-19 vaccination programme, there needs to be clarity about what is known and not known about the vaccines and transparency around the evidence-base supporting government decisions on vaccine rollout. Effort is also needed to dispel the spread of vaccine-related misinformation online and to address specific concerns, particularly among BAME and junior level HCWs. Strengths and limitations of this study • This is the first qualitative study to understand the factors influencing healthcare workers' (HCWs) attitudes towards

Research paper thumbnail of Missing the human connection: A rapid appraisal of healthcare workers' perceptions and experiences of providing palliative care during the COVID-19 pandemic

Palliative Medicine, 2021

Background: During infectious epidemics, healthcare workers are required to deliver traditional c... more Background: During infectious epidemics, healthcare workers are required to deliver traditional care while facing new pressures. Time and resource restrictions, a focus on saving lives and new safety measures can lead to traditional aspects of care delivery being neglected.

Aim: Identify barriers to delivering end-of-life care, describe attempts to deliver care during the COVID-19 pandemic, and understand the impact this had on staff.

Design: A rapid appraisal was conducted incorporating a rapid review of policies from the United Kingdom, semi-structured telephone interviews with healthcare workers, and a review of mass print media news stories and social media posts describing healthcare worker's experiences of delivering care during the pandemic. Data were coded and analysed using framework analysis. Setting/Participants: From a larger ongoing study, 22 interviews which mentioned death or caring for patients at end-of-life, eight government and National Health Service policies affecting end-of-life care delivery, eight international news media stories and 3440 publicly available social media posts were identified. The social media analysis centred around 274 original tweets with the highest reach, engagement and relevance. Incorporating multiple workstreams provided a broad perspective of end-of-life care during the COVID-19 pandemic in the United Kingdom.

Results: Three themes were developed: (1) restrictions to traditional care, (2) striving for new forms of care and (3) establishing identity and resilience.

Conclusions: The COVID-19 pandemic prohibited the delivery of traditional care as practical barriers restricted human connections. Staff prioritised communication and comfort orientated tasks to re-establish compassion at end-of-life and displayed resilience by adjusting their goals.

Research paper thumbnail of Frontline healthcare workers experiences with PPE during the COVID 19 pandemic in the UK a rapid qualitative appraisal

British Medical Journal: Open, 2021

Objectives To report frontline healthcare workers’ (HCWs) experiences with personal protective e... more Objectives
To report frontline healthcare workers’ (HCWs) experiences with personal protective equipment (PPE) during the COVID-19 pandemic in the UK. To understand HCWs’ fears and concerns surrounding PPE, their experiences following its guidance and how these affected their perceived ability to deliver care during the COVID-19 pandemic.

Methods
A rapid qualitative appraisal study combining three sources of data: semi-structured in-depth telephone interviews with frontline HCWs (n=46), media reports (n=39 newspaper articles and 145,000 social media posts) and government PPE policies (n=25).

Participants
Interview participants were HCWs purposively sampled from critical care, emergency and respiratory departments as well as redeployed HCWs from primary, secondary and tertiary care centres across the UK.

Results
A major concern was running out of PPE, putting HCWs and patients at risk of infection. Following national-level guidance was often not feasible when there were shortages, leading to re-use and improvisation of PPE. Frequently changing guidelines generated confusion and distrust. PPE was reserved for high-risk secondary care settings and this translated into HCWs outside these settings feeling inadequately protected. Participants were concerned about inequitable access to PPE for community, lower seniority, female and ethnic minority HCWs. Participants continued delivering care despite the physical discomfort, practical problems and communication barriers associated with PPE use.

Conclusion
This study found that frontline HCWs persisted in caring for their patients despite multiple challenges including inappropriate provision of PPE, inadequate training and inconsistent guidance. In order to effectively care for patients during the COVID-19 pandemic, frontline HCWs need appropriate provision of PPE, training in its use, as well as comprehensive and consistent guidance. These needs must be addressed in order to protect the health and well-being of the most valuable healthcare resource in the COVID-19 pandemic: our HCWs.

Drafts by Sasha Lewis-Jackson

Research paper thumbnail of Healthcare workers' perceptions and attitudes towards the UK's COVID-19 vaccination programme

BMJ Open, 2021

Objectives To explore healthcare workers' (HCWs) perceptions and attitudes towards the COVID-19 v... more Objectives To explore healthcare workers' (HCWs) perceptions and attitudes towards the COVID-19 vaccination programme in the UK, including their expectations, concerns and views on whether to promote vaccination to others. To understand the key factors shaping HCWs' attitudes towards COVID-19 vaccination in the UK. Design This study was designed as a rapid qualitative appraisal integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semi-structured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis. Participants Interviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies and guidelines on the vaccination programme were reviewed. Results The level of uncertainty about the vaccines' long-term safety and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HCWs felt that government decisions on vaccine rollout had not been supported by evidence-based science and this impacted their level of trust and confidence in the programme. The spread of misinformation online also impacted HCWs' attitudes towards vaccination, particularly among junior level and Black, Asian and Minority Ethnic (BAME) HCWs. Most HCWs felt encouraged to promote vaccination to their patients and the majority said they would advocate vaccination or engage in conversations about vaccination with others when relevant. Conclusion In order to improve HCWs' trust and confidence in the UK's COVID-19 vaccination programme, there needs to be clarity about what is known and not known about the vaccines and transparency around the evidence-base supporting government decisions on vaccine rollout. Effort is also needed to dispel the spread of vaccine-related misinformation online and to address specific concerns, particularly among BAME and junior level HCWs. Strengths and limitations of this study • This is the first qualitative study to understand the factors influencing healthcare workers' (HCWs) attitudes towards

Articles by Sasha Lewis-Jackson

Research paper thumbnail of UK Health Care Workers' Experiences of Major System Change in Elective Surgery during the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

International Journal of Health policy and Management, 2021

Background The COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majori... more Background The COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the UK, with the aim of developing lessons for future major systems change. Methods Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. We also carried out a policy review of the guidance developed for those delivering surgical services in pandemic conditions. We used framework analysis to organise and interpret findings. Results Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. Conclusion Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of major systems change is essential for the sustainability of change processes.

Research paper thumbnail of Perceptions of government guidance and citizen responses during the COVID-19 pandemic: A cross-country analysis

SSM - Qualitative Research in Health

Research paper thumbnail of What are the priority needs for those caring for children and young people with complex neurodisability within an ethnically diverse UK context? - The feasibility phase of the ENCOMPASS study

BackgroundChildren and young people (CYP) with complex neurodisability experience multiple physic... more BackgroundChildren and young people (CYP) with complex neurodisability experience multiple physical, communication, educational and social challenges which require complex packages of multidisciplinary care. Cerebral palsy, an exemplar complex neurodisability condition, is the most common cause of serious physical disabilities among children globally. It is unclear the best way to meet the emotional, social, practical, and empowerment needs of CYP with complex neurodisability and their caregivers. The aim of this study was to determine the needs and priorities of those caring for CYP with complex neurodisability. This forms part of the feasibility phase of a wider study (ENCOMPASS) which aims to adapt the ‘Baby Ubuntu’ intervention, a participatory caregiver programme for families of CYP with complex neurodisability, to an ethnically diverse urban UK context.MethodsTwo rounds of semi-structured interviews were conducted with 12 caregivers of CYP with complex neurodisability and six ...

Research paper thumbnail of Policies and Politics: An Analysis of Public Policies Aimed at the Reorganisation of Healthcare Delivery During the COVID-19 Pandemic

Caring on the Frontline during COVID-19, 2022

Lewis-Jackson, Sasha, Eleonora Iob, Valentina Giunchiglia, Jose Roberto Cabral, Maria Romeu-Labay... more Lewis-Jackson, Sasha, Eleonora Iob, Valentina Giunchiglia, Jose Roberto Cabral, Maria Romeu-Labayen, Silvie Cooper, Rirhandzu Makamu, et al. 2022. "Policies and Politics: An Analysis of Public Policies Aimed at the Reorganisation of Healthcare Delivery During the COVID-19 Pandemic." In Caring on the Frontline during COVID-19: Contributions from Rapid Qualitative Research, edited by Cecilia Vindrola-Padros and Ginger A. Johnson, 39-64. Singapore: Springer Singapore.

Research paper thumbnail of sj-docx-1-pmj-10.1177_02692163211004228 – Supplemental material for Missing the human connection: A rapid appraisal of healthcare workers' perceptions and experiences of providing palliative care during the COVID-19 pandemic

Supplemental material, sj-docx-1-pmj-10.1177_02692163211004228 for Missing the human connection: ... more Supplemental material, sj-docx-1-pmj-10.1177_02692163211004228 for Missing the human connection: A rapid appraisal of healthcare workers' perceptions and experiences of providing palliative care during the COVID-19 pandemic by Lucy Mitchinson, Anna Dowrick, Caroline Buck, Katarina Hoernke, Sam Martin, Samantha Vanderslott, Hannah Robinson, Felicia Rankl, Louisa Manby, Sasha Lewis-Jackson and Cecilia Vindrola-Padros in Palliative Medicine

Research paper thumbnail of Missing the human connection: A rapid appraisal of healthcare workers’ perceptions and experiences of providing palliative care during the COVID-19 pandemic

Palliative Medicine, 2021

Background: During infectious epidemics, healthcare workers are required to deliver traditional c... more Background: During infectious epidemics, healthcare workers are required to deliver traditional care while facing new pressures. Time and resource restrictions, a focus on saving lives and new safety measures can lead to traditional aspects of care delivery being neglected. Aim: Identify barriers to delivering end-of-life care, describe attempts to deliver care during the COVID-19 pandemic, and understand the impact this had on staff. Design: A rapid appraisal was conducted incorporating a rapid review of policies from the United Kingdom, semi-structured telephone interviews with healthcare workers, and a review of mass print media news stories and social media posts describing healthcare worker’s experiences of delivering care during the pandemic. Data were coded and analysed using framework analysis. Setting/Participants: From a larger ongoing study, 22 interviews which mentioned death or caring for patients at end-of-life, eight government and National Health Service policies aff...

Research paper thumbnail of Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK

BMJ Open, 2020

ObjectiveThe COVID-19 pandemic has set unprecedented demand on the healthcare workforce around th... more ObjectiveThe COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK.MethodsThe study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) in-depth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis.ResultsLimited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work....

Research paper thumbnail of UK Health Care Workers’ Experiences of Major System Change in Elective Surgery during the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

BackgroundThe COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majorit... more BackgroundThe COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the UK, with the aim of developing lessons for future major systems change.MethodsUsing a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. We also carried out a policy review of the guidance developed for those delivering surgical services in pandemic conditions. We used framework analysis to organise and interpret findings.ResultsStaff discussed positive and negative experiences of rapid service organisation. Clinician-led decision making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positiv...

Research paper thumbnail of Frontline healthcare workers’ experiences with personal protective equipment during the COVID-19 pandemic in the UK: a rapid qualitative appraisal

BMJ Open, 2021

ObjectivesTo report frontline healthcare workers’ (HCWs) experiences with personal protective equ... more ObjectivesTo report frontline healthcare workers’ (HCWs) experiences with personal protective equipment (PPE) during the COVID-19 pandemic in the UK. To understand HCWs’ fears and concerns surrounding PPE, their experiences following its guidance and how these affected their perceived ability to deliver care during the COVID-19 pandemic.DesignA rapid qualitative appraisal study combining three sources of data: semistructured in-depth telephone interviews with frontline HCWs (n=46), media reports (n=39 newspaper articles and 145 000 social media posts) and government PPE policies (n=25).ParticipantsInterview participants were HCWs purposively sampled from critical care, emergency and respiratory departments as well as redeployed HCWs from primary, secondary and tertiary care centres across the UK.ResultsA major concern was running out of PPE, putting HCWs and patients at risk of infection. Following national level guidance was often not feasible when there were shortages, leading to ...

Research paper thumbnail of Healthcare workers’ perceptions and attitudes towards the UK’s COVID-19 vaccination programme

ObjectivesTo explore healthcare workers’ (HCWs) perceptions and attitudes towards the COVID-19 va... more ObjectivesTo explore healthcare workers’ (HCWs) perceptions and attitudes towards the COVID-19 vaccination programme in the UK, including their expectations, concerns and views on whether to promote vaccination to others. To understand the key factors shaping HCWs’ attitudes towards COVID-19 vaccination in the UK.DesignThis study was designed as a rapid qualitative appraisal integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semi-structured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis.ParticipantsInterviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies and guidelines on the vaccination programme were reviewed.ResultsThe level of uncertainty about the vaccines’ long-term safety and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HC...

Research paper thumbnail of Healthcare workers' perceptions and attitudes towards the UK's COVID-19 vaccination programme: a rapid qualitative appraisal

BMJ Open, 2022

Objectives: While there is research relating to perceptions of vaccines among healthcare workers ... more Objectives: While there is research relating to perceptions of vaccines among healthcare workers (HCWs), the evidence base in relation to COVID-19 remains limited. The aim of this study was to explore HCWs’ perceptions and attitudes towards vaccines and the COVID-19 vaccination programme in the UK, including their expectations and views on promoting vaccination to others.

Design: This study was designed as a rapid qualitative appraisal, integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semistructured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis.

Participants: Interviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies, and guidelines on the vaccination programme were reviewed.

Results: The level of uncertainty about the long-term safety of vaccines and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HCWs felt that government decisions on vaccine rollout had not been supported by evidence-based science, and this impacted their level of trust and confidence in the programme. The spread of misinformation online also impacted HCWs’ attitudes towards vaccination, particularly among junior level and black, Asian and minority ethnic (BAME) HCWs. Most HCWs felt encouraged to promote vaccination to their patients, and the majority said they would advocate vaccination or engage in conversations about vaccination with others when relevant.

Conclusion: In order to improve HCWs’ trust and confidence in the UK’s COVID-19 vaccination programme, there needs to be clarity about what is known and not known about the vaccines and transparency around the evidence-base supporting government decisions on vaccine rollout. Effort is also needed to dispel the spread of vaccine-related misinformation online and to address specific concerns, particularly among BAME and junior-level HCWs.

Research paper thumbnail of Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK

BMJ, 2020

Objective The COVID-19 pandemic has set unprecedented demand on the healthcare workforce around t... more Objective The COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK. Methods The study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) indepth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis. Results Limited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work. Lack of training for redeployed staff and the failure to consider the skills of redeployed staff for new areas were identified as problems. Positive aspects of daily work reported by HCWs included solidarity between colleagues, the establishment of well-being support structures and feeling valued by society. Conclusion Our study highlighted the importance of taking into consideration the experiences and concerns of front-line staff during a pandemic. Staff working in the UK during the COVID-19 pandemic advocated clear and consistent guidelines, streamlined testing of HCWs, administration of PPE and acknowledgement of the effects of PPE on routine practice.

Research paper thumbnail of Healthcare workers' perceptions and attitudes towards the UK's COVID-19 vaccination programme

British Medical Journal, 2021

Objectives To explore healthcare workers' (HCWs) perceptions and attitudes towards the COVID-19 v... more Objectives To explore healthcare workers' (HCWs) perceptions and attitudes towards the COVID-19 vaccination programme in the UK, including their expectations, concerns and views on whether to promote vaccination to others. To understand the key factors shaping HCWs' attitudes towards COVID-19 vaccination in the UK. Design This study was designed as a rapid qualitative appraisal integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semi-structured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis. Participants Interviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies and guidelines on the vaccination programme were reviewed. Results The level of uncertainty about the vaccines' long-term safety and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HCWs felt that government decisions on vaccine rollout had not been supported by evidence-based science and this impacted their level of trust and confidence in the programme. The spread of misinformation online also impacted HCWs' attitudes towards vaccination, particularly among junior level and Black, Asian and Minority Ethnic (BAME) HCWs. Most HCWs felt encouraged to promote vaccination to their patients and the majority said they would advocate vaccination or engage in conversations about vaccination with others when relevant. Conclusion In order to improve HCWs' trust and confidence in the UK's COVID-19 vaccination programme, there needs to be clarity about what is known and not known about the vaccines and transparency around the evidence-base supporting government decisions on vaccine rollout. Effort is also needed to dispel the spread of vaccine-related misinformation online and to address specific concerns, particularly among BAME and junior level HCWs. Strengths and limitations of this study • This is the first qualitative study to understand the factors influencing healthcare workers' (HCWs) attitudes towards

Research paper thumbnail of Missing the human connection: A rapid appraisal of healthcare workers' perceptions and experiences of providing palliative care during the COVID-19 pandemic

Palliative Medicine, 2021

Background: During infectious epidemics, healthcare workers are required to deliver traditional c... more Background: During infectious epidemics, healthcare workers are required to deliver traditional care while facing new pressures. Time and resource restrictions, a focus on saving lives and new safety measures can lead to traditional aspects of care delivery being neglected.

Aim: Identify barriers to delivering end-of-life care, describe attempts to deliver care during the COVID-19 pandemic, and understand the impact this had on staff.

Design: A rapid appraisal was conducted incorporating a rapid review of policies from the United Kingdom, semi-structured telephone interviews with healthcare workers, and a review of mass print media news stories and social media posts describing healthcare worker's experiences of delivering care during the pandemic. Data were coded and analysed using framework analysis. Setting/Participants: From a larger ongoing study, 22 interviews which mentioned death or caring for patients at end-of-life, eight government and National Health Service policies affecting end-of-life care delivery, eight international news media stories and 3440 publicly available social media posts were identified. The social media analysis centred around 274 original tweets with the highest reach, engagement and relevance. Incorporating multiple workstreams provided a broad perspective of end-of-life care during the COVID-19 pandemic in the United Kingdom.

Results: Three themes were developed: (1) restrictions to traditional care, (2) striving for new forms of care and (3) establishing identity and resilience.

Conclusions: The COVID-19 pandemic prohibited the delivery of traditional care as practical barriers restricted human connections. Staff prioritised communication and comfort orientated tasks to re-establish compassion at end-of-life and displayed resilience by adjusting their goals.

Research paper thumbnail of Frontline healthcare workers experiences with PPE during the COVID 19 pandemic in the UK a rapid qualitative appraisal

British Medical Journal: Open, 2021

Objectives To report frontline healthcare workers’ (HCWs) experiences with personal protective e... more Objectives
To report frontline healthcare workers’ (HCWs) experiences with personal protective equipment (PPE) during the COVID-19 pandemic in the UK. To understand HCWs’ fears and concerns surrounding PPE, their experiences following its guidance and how these affected their perceived ability to deliver care during the COVID-19 pandemic.

Methods
A rapid qualitative appraisal study combining three sources of data: semi-structured in-depth telephone interviews with frontline HCWs (n=46), media reports (n=39 newspaper articles and 145,000 social media posts) and government PPE policies (n=25).

Participants
Interview participants were HCWs purposively sampled from critical care, emergency and respiratory departments as well as redeployed HCWs from primary, secondary and tertiary care centres across the UK.

Results
A major concern was running out of PPE, putting HCWs and patients at risk of infection. Following national-level guidance was often not feasible when there were shortages, leading to re-use and improvisation of PPE. Frequently changing guidelines generated confusion and distrust. PPE was reserved for high-risk secondary care settings and this translated into HCWs outside these settings feeling inadequately protected. Participants were concerned about inequitable access to PPE for community, lower seniority, female and ethnic minority HCWs. Participants continued delivering care despite the physical discomfort, practical problems and communication barriers associated with PPE use.

Conclusion
This study found that frontline HCWs persisted in caring for their patients despite multiple challenges including inappropriate provision of PPE, inadequate training and inconsistent guidance. In order to effectively care for patients during the COVID-19 pandemic, frontline HCWs need appropriate provision of PPE, training in its use, as well as comprehensive and consistent guidance. These needs must be addressed in order to protect the health and well-being of the most valuable healthcare resource in the COVID-19 pandemic: our HCWs.

Research paper thumbnail of Healthcare workers' perceptions and attitudes towards the UK's COVID-19 vaccination programme

BMJ Open, 2021

Objectives To explore healthcare workers' (HCWs) perceptions and attitudes towards the COVID-19 v... more Objectives To explore healthcare workers' (HCWs) perceptions and attitudes towards the COVID-19 vaccination programme in the UK, including their expectations, concerns and views on whether to promote vaccination to others. To understand the key factors shaping HCWs' attitudes towards COVID-19 vaccination in the UK. Design This study was designed as a rapid qualitative appraisal integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semi-structured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis. Participants Interviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies and guidelines on the vaccination programme were reviewed. Results The level of uncertainty about the vaccines' long-term safety and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HCWs felt that government decisions on vaccine rollout had not been supported by evidence-based science and this impacted their level of trust and confidence in the programme. The spread of misinformation online also impacted HCWs' attitudes towards vaccination, particularly among junior level and Black, Asian and Minority Ethnic (BAME) HCWs. Most HCWs felt encouraged to promote vaccination to their patients and the majority said they would advocate vaccination or engage in conversations about vaccination with others when relevant. Conclusion In order to improve HCWs' trust and confidence in the UK's COVID-19 vaccination programme, there needs to be clarity about what is known and not known about the vaccines and transparency around the evidence-base supporting government decisions on vaccine rollout. Effort is also needed to dispel the spread of vaccine-related misinformation online and to address specific concerns, particularly among BAME and junior level HCWs. Strengths and limitations of this study • This is the first qualitative study to understand the factors influencing healthcare workers' (HCWs) attitudes towards

Research paper thumbnail of UK Health Care Workers' Experiences of Major System Change in Elective Surgery during the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

International Journal of Health policy and Management, 2021

Background The COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majori... more Background The COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the UK, with the aim of developing lessons for future major systems change. Methods Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. We also carried out a policy review of the guidance developed for those delivering surgical services in pandemic conditions. We used framework analysis to organise and interpret findings. Results Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. Conclusion Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of major systems change is essential for the sustainability of change processes.