During the COVID-19 pandemic, visiting restrictions of different extents have been implemented. However, despite the long history of visiting restrictions in health care systems, little is known about their effects. This review sought to explore the consequences of visitor restrictions in health care services during the COVID-19 pandemic. A systematic, integrative review was conducted in accordance with the PRISMA guidelines, based on a systematic search in PubMed, CHINAL full plus, Web of Science, PsychInfo, Scopus and the Cochrane Library. A total of 17 scientific papers covering intensive care, pediatric care, general medical care, hospital care, palliative care and nursing home settings were included. Although appreciation for the technical solutions enabling remote meetings was reported, visiting restrictions had several consequences, mainly negative, for the patient's health, the health and wellbeing of family members and the provision of care. Among physical health consequences, reduced nutrition intake, decreased activities of daily living and increased physical pain and symptoms were reported. Among mental health consequences for the patient, loneliness, depressive symptoms, agitation, aggression, reduced cognitive ability and overall dissatisfaction were observed. For family members, worry, anxiety and uncertainty occurred, and they reported an increased need for information from care providers. Family members of neonatal intensive care unit patients reported less bonding with their child and family relation disturbances due to the restrictions. For care providers, visiting restrictions added the burdens of ethical dilemmas, learning new technical means to enable social interaction and an increased demand for communication with families and providing social support to both family members and patients. When implementing visiting restrictions in health care services, decision makers and nurses need to be aware of their potential negative effects and adapt the provision of care to compensate for such effects. Nurses in all sectors should be aware that visiting restrictions may affect patients, families, and health care services for longer than the actual pandemic. Since the level of evidence regarding effect from visiting restrictions is low, further studies is strongly needed.

Background: Managing mass casualty or disaster incidents is challenging to any person or organisation. Therefore, this paper identifies and describes common challenges to managing such situations, using case and lessons learned reports. It focuses on sudden onset, man-made or technologically caused mass casualty or disaster situations. Methods: A management review was conducted based on a structured search in the PubMed and Web of Science databases. Results: The review included 20 case—and lessons learned reports covering natural disasters, man-made events, and accidents across Europe, the United States of Amerika (USA), Asia and the Middle East. Five common challenges were identified: (1) to identify the situation and deal with uncertainty, (2) to balance the mismatch between the contingency plan and the reality, (3) to establish a functional crisis organization, (4) to adapt the medical response to the actual and overall situation and (5) to ensure a resilient response. Conclusions: The challenges when managing mass casualty or disaster events involved were mainly related to the ability to manage uncertainty and surprising situations, using structured processes to respond. The ability to change mind set, organization and procedures, both from an organizational- and individual perspective, was essential. Non-medical factors and internal factors influenced the medical management. In order to respond in an effective, timely and resilient way, all these factors should be taken into consideration.

To investigate differences and describe experiences of postoperative recovery after day surgery between patients undergoing general anesthesia (GA) versus regional anesthesia (RA). A mixed methods design. Day surgery patients (N = 401) were included. Postoperative recovery was assessed daily for 14 days using the Swedish Web Version of the Quality of Recovery questionnaire included in a mobile application. In addition, qualitative interviews were completed with 20 day surgery patients. Quantitative and qualitative data were first analyzed separately and then merged. There were significant differences in Swedish Web Version of the Quality of Recovery between GA and RA on days 1 to 13 (P < .05). These findings could not be confirmed in the qualitative findings, except for psychological issues as well as tiredness and fatigue. Unexpected issues contributed to a greater extent to the theme not feeling well. Pain in the surgical wound was overall the biggest problem. There seems to be a poorer recovery after GA compared with RA. Tiredness or fatigue is present also after minor surgery in RA. Unexpected issues affect recovery negatively, and therefore should be addressed by health care.

Aim: The aim of this study was to understand the lived experience of altruism and sacrifices among Swedish nurses working in intensive care units (ICU) during the COVID‐19 pandemic.Design: This was a descriptive phenomenological study.Methods: The study was conducted between June 2020 and March 2021 and included 20 nurses who were directly involved in the ICU care of COVID‐19 patients in Sweden during the pandemic. The text transcripts were analysed using Malterud's Systematic Text Condensation.Findings: The analysis revealed four themes. The work situation changed from 1 day to another—the nurses were brutally confronted with a new and highly demanding situation. Adapting to the chaotic situation—despite fear, anguish and exhaustion, the nurses adapted to the new premises. They shouldered the moral responsibility and responded to the needs of the patients and the health care system since they had the competence. Being confronted with ethical and moral challenges—the nurses were overwhelmed by feelings of helplessness and inadequacy because despite how hard they worked, they were still unable to provide care with dignity and of acceptable quality. The importance of supporting each other—collegiality was fundamental to the nurses' ability to cope with the situation.Conclusions: Taken together, being exposed to a constantly changing situation, facing the anguish and misery of patients, families, and colleagues, and being confronted with a conflict between the moral obligation to provide care of high quality and the possibility to fulfil this commitment resulted in suffering among the nurses. Collegial back‐up and a supportive culture within the caring team were important for the nurses' endurance.Impact: The study contributes an understanding of nurses' lived experience of working during the COVID‐19 pandemic and highlights the importance of protecting and preparing nurses and nursing organisation for potential future crises.

Background: In November 2013, the Haiyan typhoon hit parts of the Philippines. The typhoon caused severe damage to the medical facilities and many injuries and deaths. Health professionals have a crucial role in the immediate disaster response system, but knowledge of their experiences of working during and in the immediate aftermath of a natural disaster is limited.Aim: The aim of this study was to explore health professionals’ experiences of working during and in the immediate aftermath of a natural disaster.Method: Eight health professionals were interviewed five months after the disaster. The interviews were analyzed using phenomenological hermeneutic methods.Results: The main theme, being professional and survivor, described both positive and negative emotions and experiences from being both a helper, as part of the responding organization, and a victim, as part of the surviving but severely affected community. Sub-themes described feelings of strength and confidence, feelings of adjustment and acceptance, feelings of satisfaction, feelings of powerless and fear, feelings of guilt and shame, and feelings of loneliness.Conclusion: Being a health professional during a natural disaster was a multi-faceted, powerful, and ambiguous experience of being part of the response system at the same time as being a survivor of the disaster. Personal values and altruistic motives as well as social aspects and stress-coping strategies to reach a balance between acceptance and control were important elements of the experience. Based on these findings, implications for disaster training and response strategies are suggested. Hugelius K , Adolfsson A , Örtenwall P , Gifford M .Being both helpers and victims: health professionals’ experiences of working during a natural disaster.Prehosp Disaster Med.2017;32(2):117–123.