Exploring the Experiences of Front-line Nurses during the COVID-19 Pandemic

NOTICE OF INTENT TO ISSUE AN ORDER/CONTRACT. This is not a request for competitive proposals/quotes. The Centers for Disease Control and Prevention (CDC), National Center for Occupational Safety and Health (NIOSH), hereby announces its intent to issue a sole source order/contract to The Brigham and Women’s Hospital, Inc. 75 Francis Street. Boston, MA 02115. The NAICS code for this acquisition is 541990 All Other Professional, Scientific and Technical Services, with a size standard of $16.5 million. _______DRAFT SOW________ Exploring the Experiences of Front-line Nurses during the COVID-19 Pandemic BACKGROUND While performing critically important work, healthcare professionals encounter occupational exposures that could adversely affect their own health and could even be deadly. There is an urgent need to understand the physical and psychosocial stressors on American nurses during the COVID-19 pandemic, as well as the personal and institutional responses that exacerbate or mitigate the impact of those stressors. During this pandemic, access to adequate personal protective equipment (PPE) is a life-and-death matter. Anecdotal reports in the news suggest that nurses are reusing PPE when they would not normally do so; while some sites have obtained PPE disinfection units, others have not. Because this PPE shortage is sudden and novel for the U.S., there is a lack of data on the ingenuity as well as the frustration and fears this situation has engendered. Furthermore, during this pandemic, nurses are under novel and increasing psychologic stress at work. Some of this stress is predictable: exhaustion, despair and burnout. Yet many healthcare workers who work in elective care sectors have instead faced sudden, unexpected layoffs. Others find themselves under novel work stressors, such as redeployment to an intensive care unit or delivering telemedicine for the first time. As essential workers, many nurses also face a wrenching conflict: they are required to report for work, and yet are expected to find solutions for childcare of offspring whose schools have closed their doors. Many also worry about bringing home infection to vulnerable family members. Because this pandemic is new, our standard methods of measuring stress by quantitative surveys are limited. We need to hear how nurses are coping during the pandemic, in their own words. We have a unique opportunity to perform qualitative research on the experiences of nurses across the U.S. Data are being collected by Harvard University and Brigham and Women’s Hospital via a series of COVID-19 surveys nested within three longitudinal ‘Harvard Cohorts.’ The three cohorts are comprised of the Nurses’ Health Study 3 (NHS3, currently aged 18-55 years), NHSII (currently aged 56-75 years) and their offspring enrolled in the Growing Up Today Study (GUTS; currently aged 33 to 41 years). Participants in these cohorts include over 100,000 participants, of whom the majority are nurses. On April 21, Harvard investigators launched a series of REDCap electronic surveys to capture participants’ changing occupational experiences, including use of PPE and psychosocial stress. The Harvard Cohorts study will rapidly collect information via web questionnaire over a six month period on COVID-19 infection, regarding stressors (occupational, financial, caregiving), mental health and nutrition related to the pandemic among members of the three cohorts. PURPOSE The contractor shall conduct analyses of the qualitative data they are collecting from nurses in open fields of the surveys. Hearing about nurses’ experiences in their own words, will expand our understanding of their stressors, sources of resilience, and barriers to safety and effectiveness. Specific Aim: To conduct mixed methods research on a series of COVID-19 surveys administered to a large population of American nurses, to yield nuanced, novel insights into their experiences of the pandemic. Subsetting the population by factors of interest, the contractors shall identify: i) The major stressors on nurses during the pandemic ii) Nurses’ experiences with PPE shortages and work-arounds iii) How nurses have coped with the pandemic, at work and at home SCOPE OF WORK The contractor shall prepare and analyze data from the three “Harvard Cohorts” (NHS2, NHS3, and GUTS), including data from the open text fields, on psychosocial stress, exposure to Coronavirus, use and availability of PPE, and outcomes such as COVID-19 diagnoses in accordance with the technical requirements and deliverables described below. TASKS TO BE PERFORMED At the direction of the NIOSH Point of Contact, the contractor shall prepare for analysis variables from the COVID-19 series of questionnares sent to the Harvard Cohorts. The contractor shall conduct statistical analyses on these variables. The contractor shall retain the dataset but provide the NIOSH Point of Contact with tables that summarize the results. Task 1: To extract and prepare open field data for analysis: The datasets to be used were collected by Harvard and Brigham and Women’s Hospital from a combination of participants from the NHS2, NHS3, and GUTS (referred to as the “Harvard Cohorts”). The contractor shall use content analysis methodology [Hsieh H-F, Shannon SE. Qual Health Res. 2005;15:1277–88] to code themes from the data contributed by nurses in the open fields of the COVID-19 surveys. Entries shall be coded by independent researchers, with coders independently reviewing every response for recurrent themes which they will categorize and sub-categorize. The contractors, along with NIOSH project officers, shall determine the most relevant population subsets to examine (for example, type of nursing work, geographic location, age, etc.) Task 2: To establish a codebook for analyzing the qualitative data: Coders shall compare emerging categories with each other to determine their substance and significance. This consensus process yields an initial codebook, with collapsed and defined codes. Researchers will then employ the codebook to re-code 20% of entries to evaluate consensus (goal≥ 0.7). Discrepancies shall be resolved by consensus and codebook modification. This process shall be repeated on separate entries, until adequate inter-coder reliability is achieved; a final code book is then generated, which will be used to recode the whole dataset. Task 3: Using the finalized codebook, to review open field data to extract themes, stopping when saturation is reached Data analysis stops when ‘saturation’ is reached and no further new information or insight is forthcoming. Task 4: Draft one or more manuscripts summarizing the findings: Representative quotations from participants shall be included in the manuscript(s) to illustrate the themes. Actionable findings that might improve nurses’ well-being and health during this and future pandemics shall be highlighted. Methods and variables of interest: The data resource is comprised of a series of COVID-19 surveys nested within three longitudinal ‘Harvard Cohorts,’ including the Nurses’ Health Study3 (NHS3, currently aged 18-55 years), NHSII (currently aged 56-75 years) and their offspring enrolled in the Growing Up Today Study (GUTS; currently aged 33 to 41 years). Participants in these cohorts include over 100,000 participants, of whom the majority are nurses. On April 21, the Harvard investigators launched a series of REDCap electronic surveys to capture their changing occupational experiences, including use of PPE and psychosocial stress. These COVID-19 surveys include: - a baseline questionnaire for the entire population (rolled out in stages starting April 21) - weekly questionnaires to actively practicing healthcare workers, focused on PPE - monthly surveys to the entire three-cohort population - a final wrap-up survey, targeted for six months after the baseline These COVID-19 surveys query worksite, exposure to COVID-19 positive patients, use of PPE, infection and antibody status, symptoms and hospitalization. Monthly surveys quantify psychosocial stress (including burn-out, role conflict, depression and PTSD) and other items using standardized scales. Each survey includes several ‘open text fields’ that allow participants to write in comments. For example, the baseline questionnaire includes four open text fields. Two of these are simple boxes prompting ‘Comments.’ Two other open fields are more directive, and query: - ‘Please include any information about your use of improvised, non-standard PPE’ - ‘We are interested in learning more about your experiences during this pandemic. Please add anything else you would like to tell us’ As of 5/19/20, 105,583 participants were emailed; almost 55,000 (52%) have already completed the baseline survey. Reminder emails are being sent. There are already 15,000 active HCWs participating in the weekly surveys (of which over 22,000 have already been received), indicating a robust response from active HCWs. The first monthly survey was launched the week of May 18, 2020. Based on early indications that approximately 60% of respondents are writing comments in the open text fields, we estimate that up to several tens of thousands of qualitative data points will be collected. In consultation with NIOSH project officers, Harvard investigators shall subset the population by factors of interest, such as: - worksite [hospital site (ICU, ER, other inpatient, etc); dedicated COVID-19 facility; nursing home; home health; etc.] - geographic location (based on geographic information on infection rates) - demographics, such as age or race/ethnicity - whether or not participants have school-age children - vulnerability to pandemic stress by virtue of depression, anxiety or PTSD (in the past or currently) - status of becoming infected with COVID-19. To date, Harvard investigators have conducted feasibility by scanning the open text fields as surveys come in (to detect any issues with survey completion, or changes in participant contact information). Based on the first 500 responses of the feasibility study, it’s clear that many nurses are frustrated with competing demands and expectations. They are reporting being worried about bringing the virus home. Several have described PPE shortages. Others mention guilty feelings if they are not on the frontlines. Those who have been furloughed are anxious about making ends meet. But there are also many nurses who are grateful for extra time with family and gratified to be able to contribute on the frontlines of the pandemic. These are some of the themes that will capture with standardized qualitative research techniques. PERIOD OF PERFORMANCE Period of performance shall be from date of award to last for 12 months. _____________________________ A determination by the Government not to compete this proposed action will be based on responses to this notice and is solely in the discretion of the Contracting Officer. Information received will be considered solely for the purpose of determining whether to conduct a competitive procurement. All vendors must be registered in the System for Award Management (SAM) at www.sam.gov , prior to an award of a federal contract. This action is for supplies or services for which the Government intends to solicit and negotiate with only one source under the authority of FAR 13.106-1(b) and 10 U.S.C. 2304(c)(1). Interested persons may identify their interest and capability to respond to the requirement or submit quotations. This is not a request for competitive quotations ; however, the Government will review any/all product, capabilities, and pricing information submitted prior to the closure of this notice. A determination by the government not to compete this proposed contract based upon responses to this notice is solely within the discretion of the government. Information received will normally be considered solely for the purpose of determining whether to conduct a competitive procurement. Responsible sources that believe they possess the expertise and capabilities identified above are hereby afforded the opportunity to submit to the Contracting Officer within 5 days from the posting date of this notice, their written capabilities statement and pricing information in the format they choose, not to exceed 10 pages. Please forward product and pricing information to Diane Meeder, Contracting Officer, CDC, OAS, through email at [email protected]. Any responses should be emailed to Diane Meeder at [email protected] by July 1, 2020 at 12:00 P.M. ET .