Collins Noah, Crowder Jolie, Ishcomer-Aazami Jamie, Apedjihoun Dionne
National Council of Urban Indian Health, Technical Assistance and Research Center, Washington, DC, United States.
International Association for Indigenous Aging, Silver Spring, MD, United States.
Front Sociol. 2021 Apr 30;6:611961. doi: 10.3389/fsoc.2021.611961. eCollection 2021.
Coronavirus disease 2019 (COVID-19) has created significant challenges for outpatient healthcare providers and patients across the United States (U.S.). Forty-one Urban Indian Organizations (UIOs), who provide a wide spectrum of health services for American Indian and Alaska Native (AI/AN) populations and other underinsured and uninsured populations in urban areas across the country, are no exception. The National Council of Urban Indian Health (NCUIH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), set out to understand the needs, challenges, and opportunities for improvement in infection prevention and control (IPC) training and systems from the perspective of UIO frontline healthcare workers. As part of the CDC's , NCUIH was chosen as a partner in a national collaborative. The first task was to conduct listening sessions with frontline UIO staff to learn more about IPC practices in the context of the COVID-19 pandemic. Thirty staff from 16 UIOs, representing full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential treatment programs participated in virtual video focus groups in July of 2020. Thematic and content analysis protocols guided data analysis and coding. Analysis of findings generated four major themes: staff adaptation in the context of resilience; responsibility and duty to protect patients, families, and coworkers; mental and emotional issues for UIO staff; and IPC challenges in the context of COVID-19. Participants' challenges ranged from lack of access to personal protective equipment (PPE) to the absence of standardized training. Significant disparities in social determinants of health experienced by Native American and non-Native populations served by UIOs create additional challenges to the delivery of and access to care during the pandemic. The diverse array of tribal cultural values and contexts of the people and communities served by UIOs reportedly serve as both facilitators and barriers to care, awareness, and uptake of infectious disease public health practices.
2019年冠状病毒病（COVID-19）给美国各地的门诊医疗服务提供者和患者带来了巨大挑战。41个城市印第安人组织（UIO）也不例外，这些组织为美国印第安人和阿拉斯加原住民（AI/AN）群体以及全国城市地区其他未充分投保和未投保群体提供广泛的健康服务。城市印第安人健康全国理事会（NCUIH）与美国疾病控制与预防中心（CDC）合作，从UIO一线医护人员的角度出发，着手了解感染预防与控制（IPC）培训及系统方面的需求、挑战和改进机会。作为CDC项目的一部分，NCUIH被选为全国合作项目的合作伙伴。首要任务是与UIO一线工作人员进行听取意见会议，以了解更多COVID-19大流行背景下的IPC实践情况。2020年7月，来自16个UIO的30名工作人员参加了虚拟视频焦点小组，他们代表了全面门诊、有限门诊、外展与转诊以及门诊和住院治疗项目。主题和内容分析方案指导数据分析和编码。对研究结果的分析产生了四个主要主题：韧性背景下的员工适应；保护患者、家属和同事的责任与义务；UIO工作人员的心理和情感问题；以及COVID-19背景下的IPC挑战。参与者面临的挑战包括难以获得个人防护装备（PPE）到缺乏标准化培训等。UIO所服务的美国原住民和非原住民人群在健康的社会决定因素方面存在显著差异，这在大流行期间给医疗服务的提供和获取带来了额外挑战。据报道，UIO所服务的人群和社区中多样的部落文化价值观和背景既是护理、传染病公共卫生实践的知晓和采用的促进因素，也是障碍。
