Learning from COVID-19: Cross-sectional e-survey of critical care nurses' satisfaction and experiences of their role in the pandemic response across the United Kingdom.

BACKGROUND: Since the start of the global COVID-19 pandemic in 2019, critical care nurses across the world have been working under extreme levels of pressure. AIM: To understand critical care nurses' experiences of and satisfaction with their role in the pandemic response across the United Kingdom (UK). STUDY DESIGN: A cross-sectional electronic survey of critical care nurses (n = 339) registered as members of the British Association of Critical Care Nurses. Anonymous quantitative and open-ended question data were collected in March and April 2021 during the height of the second surge of COVID-19 in the UK via an online questionnaire. Quantitative data were analysed using descriptive statistics and free text responses were collated and analysed thematically. RESULTS: There was a response rate of 17.5%. Critical care nurses derived great satisfaction from making a difference during this global crisis and greatly valued teamwork and support from senior nurses. However, nurses consistently expressed concern over the quality of safe patient care, which they perceived to be suboptimal due to staff shortages and a dilution of the specialist skill mix. Together with the high volume of patient deaths, critical care nurses reported that these stressors influenced their personalwell-being. CONCLUSIONS: This study provides insights into the key lessons health care leaders must consider when managing the response to the demands and challenges of the ongoing COVID-19 pandemic. COVID-19 is unpredictable in its course, and what future variants might mean in terms of transmissibility, severity and resultant pressures to critical care remains unknown. RELEVANCE TO CLINICAL PRACTICE: Future responses to the challenges that critical care faces must consider nurses' experiences and create an environment that engenders supportive teamwork, facilitates excellent nursing practice and effective safe patient care where critical care nursing may thrive.

'Doing the best we can': Registered Nurses' experiences and perceptions of patient safety in intensive care during COVID-19.

AIMS: To explore registered nurses' experiences of patient safety in intensive care during COVID-19. DESIGN: A qualitative interview study informed by constructivism. METHOD: Semi-structured interviews were conducted and audio-recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework. RESULTS: Two key themes were identified. 'On a war footing'-an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. 'Doing the best we can'-Safe Delivery of Care which describes the ramifications of the actions taken on short- and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer Support. CONCLUSION: Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an understanding of the holistic and long-term impacts on patient safety and recovery from critical illness. IMPACT: This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing workforce modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals.

Recognizing and managing a deteriorating patient: a randomized controlled trial investigating the effectiveness of clinical simulation in improving clinical performance in undergraduate nursing students.

AIMS: To report the results of a randomized controlled trial which explored the effectiveness of clinical simulation in improving the clinical performance of recognizing and managing an adult deteriorating patient in hospital. BACKGROUND: There is evidence that final year undergraduate nurses may lack knowledge, clinical skills and situation awareness required to manage a deteriorating patient competently. The effectiveness of clinical simulation as a strategy to teach the skills required to recognize and manage the early signs of deterioration needs to be evaluated. DESIGN: This study was a two centre phase II single, randomized, controlled trial with single blinded assessments. METHOD: Data were collected in July 2013. Ninety-eight first year nursing students were randomized either into a control group, where they received a traditional lecture, or an intervention group where they received simulation. Participants completed a pre- and postintervention objective structured clinical examination. General Perceived Self Efficacy and Self-Reported Competency scores were measured before and after the intervention. Student satisfaction with teaching was also surveyed. RESULTS: The intervention group performed significantly better in the post-objective structured clinical examination. There was no significant difference in the postintervention General Perceived Self Efficacy and Self-Reported Competency scores between the control and intervention group. The intervention group was significantly more satisfied with their teaching method. CONCLUSION: Simulation-based education may be an effective educational strategy to teach nurses the skills to effectively recognize and manage a deteriorating patient.

Patients' experiences of technology and care in adult intensive care.

AIMS: To investigate patients' experiences of technology in an adult intensive care unit. BACKGROUND: Technology is fundamental to support physical recovery from critical illness in Intensive Care Units. As well as physical corollaries, psychological disturbances are reported in critically ill patients at all stages of their illness and recovery. Nurses play a key role in the physical and psychological care of patients;, however, there is a suggestion in the literature that the presence of technology may dehumanise patient care and distract the nurse from attending to patients psychosocial needs. Little attention has been paid to patients' perceptions of receiving care in a technological environment. DESIGN: This study was informed by Heideggerian phenomenology. METHODS: The research took place in 2009-2011 in a university hospital in England. Nineteen participants who had been patients in ICU were interviewed guided by an interview topic prompt list. Interviews were transcribed verbatim and analysed using Van Manen's framework. FINDINGS: Participants described technology and care as inseparable and presented their experiences as a unified encounter. The theme 'Getting on with it' described how participants endured technology by 'Being Good' and 'Being Invisible'. 'Getting over it' described why participants endured technology by 'Bowing to Authority' and viewing invasive technologies as a 'Necessary Evil'. CONCLUSION: Patients experienced technology and care as a series of paradoxical relationships: alienating yet reassuring, uncomfortable yet comforting, impersonal yet personal. By maintaining a close and supportive presence and providing personal comfort and care nurses may minimize the invasive and isolating potential of technology.

Critical care nurses' experiences of grief in an adult intensive care unit.

AIM: This paper is a report a study of critical care nurses' experiences of grief and their coping mechanisms when a patient dies. BACKGROUND: The goal of patients entering critical care is survival and recovery. However, despite application of advanced technologies and intensive nursing care, many patients do not survive their critical illness. Nurses experience death in their everyday work, exposing them to the emotional and physical repercussions of grief. METHOD: This study adopted a Heideggerian phenomenological approach, interviewing eight critical care nurses. Data collection occurred in 2007/8. Interviews were transcribed verbatim and themes generated through Colaizzi's framework. FINDINGS: Participants reported feelings of grief for patients they had cared for. The death of a patient was reported as being less traumatic if the participant had perceived the death to be a 'good death', incorporating expectedness and good nursing care. They described how a patient's death was more significant if it 'struck a chord', or if they had developed 'meaningful engagement' with the patient and relatives. They denied accessing formal support: however, informal conversations with colleagues were described as a means of coping. Participants exhibited signs of normalizing death and described how they disassociated themselves emotionally from dying patients. CONCLUSION: There are many predisposing factors and circumstantial occurrences that shape both the nature of care of the dying and subsequent grief. Repeated exposure to death and grief may lead to occupational stress, and ultimately burn out. Emotional disengagement from caring for the dying may have an impact on the quality of care for both the dying patient and their family.

Death, empathy and self preservation: the emotional labour of caring for families of the critically ill in adult intensive care.

AIM AND OBJECTIVE: The purpose of this phenomenological study is to explore the emotional labour nurses' face when caring for relatives of the critically ill in intensive care unit. BACKGROUND: The admission of a critically ill patient into adult intensive care is a crisis for both patients and their families. Family members of the critically ill may experience extreme levels of stress and emotional turmoil throughout the course of the relative's illness. A central tenet of providing holistic nursing care in the intensive care unit is to care for both patients and their families, however, the emotional involvement required places considerable demands on those delivering care. The support health care providers require is frequently overlooked in these challenging environments. DESIGN: Heideggerian phenomenological approach was adopted. METHODS: A purposive sample of 12 registered nurses working in an adult intensive care unit were interviewed. Interview transcripts were analysed using Colaizzi's framework. Data were collected in autumn 2005. RESULTS: Analysis of the participants' interview transcripts revealed the following themes: significance of death, establishing trust, information giving, empathy, intimacy and self preservation. CONCLUSIONS: Emotional work forms an important part of the critical care nurses job. The significance of death, breaking bad news and interpersonal relationships are sources of emotional stress for the critical care nurse caring for the family of the critically ill. The impact of this stress on the nurse and the care they deliver requires further investigation. RELEVANCE TO CLINICAL PRACTICE: Registered nurses caring for families who have relatives in adult intensive care units expand considerable emotional labour. Potentially, unless appropriately supported and managed, emotional labour may lead to occupational stress and ultimately burnout.

Nurses' experiences of caring for families with relatives in intensive care units.

AIM: This paper reports an exploratory study of nurses' experiences of caring for families who have relatives in adult intensive care units. BACKGROUND: The admission of a critically ill patient into adult intensive care is universally accepted as a crisis for both patients and their families. Family members of critically ill people may experience emotional turmoil and therefore have many needs throughout the course of the relative's illness. It has been identified that nurses are best placed to meet families' needs. Whilst there is a substantial evidence base associated with family needs, little is known about nurses' experiences of caring for these families. METHOD: Interviews, informed by Heideggerian philosophy, were conducted with a purposive sample of 12 Registered Nurses working in an adult intensive care unit. Interview transcripts were analysed using Colaizzi's framework. The data were collected in Autumn 2005. FINDINGS: Participants' experiences were categorized into the following themes: defining the nurse's role, role expectations and role conflict. Participants reported lack of confidence, doubts about their professional competence and conflicts between their professional and personal self. These experiences were linked to participants' expectations and self-imposed standards. CONCLUSION: Registered Nurses caring for families who have relatives in adult intensive care units face a fundamental conflict both between role expectations and patient care and between professional ideals and being a human. This not only highlights a disparity between nurses everyday family care practice and the underpinning theories but also may contribute to occupational stress.