A critical incident study of ICU nurses during the COVID-19 pandemic

Abstract

Background: Intensive care unit nurses are providing care to COVID-19 patients in a stressful environment. Understanding intensive care unit nurses’ sources of distress is important when planning interventions to support them. Purpose: To describe Canadian intensive care unit nurse experiences providing care to COVID-19 patients during the second wave of the pandemic. Design: Qualitative descriptive component within a larger mixed-methods study. Participants and research context: Participants were invited to write down their experiences of a critical incident, which distressed them when providing nursing care. Thematic analysis was used to analyze the data. Ethical considerations: The study was approved by the ethics committee at the researchers’ university in eastern Canada. Results: A total of 111 critical incidents were written by 108 nurses. Four themes were found: (1) managing the pandemic, (2) witness to families’ grief, (3) our safety, and (4) futility of care. Many nurses’ stories also focused on the organizational preparedness of their institutions and concerns over their own safety. Discussion: Nurses experienced moral distress in relation to family and patient issues. Situations related to insufficient institutional support, patient, and family traumas, as well as safety issues have left nurses deeply distressed. Conclusion: Identifying situations that distress intensive care unit nurses can lead to targeted interventions mitigating their negative consequences by providing a safe work environment and improving nurses’ well-being.

The extraordinary makes the ordinary visible - nursing students’ experiences of their learning in clinical practice during COVID-19: a qualitative study

“…A need for more psychosocial support, regular contact with the clinical supervisor, recognition of the difficult work situation and more space to unwind have been emphasised [33]. However, it requires a safe working environment for the supervisors as nurses have reported that insufficient institutional support during the COVID-19 pandemic caused stress [44]. None of the organisations in the present study seem to have been prepared to handle the learning situation for the students in the emerging crisis.…”

Experiences of intensive care unit nurses working with COVID-19 patients: A systematic review and meta-synthesis of qualitative studies

“…An overview of the included studies ( n = 19) has been illustrated in Table 2 . Nine articles were published in 2021 ( 29 – 32 , 34 , 36 , 38 , 41 , 42 ) and 10 were published in 2022 ( 27 , 28 , 33 , 35 , 37 , 39 , 40 , 43 – 45 ).…”

“…Five studies were from Turkey ( 28 , 33 , 39 , 44 , 45 ) three from Iran ( 31 , 41 , 42 ), two from the USA ( 30 , 36 ), two from Spain ( 34 , 35 ), two from Sweden ( 27 , 29 ), one from China ( 38 ), one from Israel ( 37 ), one from Brazil ( 32 ), one from Canada ( 43 ), and one from Taiwan ( 40 ). The included studies were conducted in various contexts, in terms of the healthcare system, the number of deaths and cases of COVID-19, the nurse-to-patient ratio, economic and political status, population age pyramid, culture, equipment, and access to health services.…”

Fundamental drivers of nurses’ experiences of ICU surging during the coronavirus disease 2019 (COVID-19) pandemic

“…This has led to fear of contracting COVID-19 and of transmitting the virus to their relatives, with these two fears expressed by 30.3% and 52.5% of ICU nurses, respectively, in a study conducted in the first COVID-19 surge in the Netherlands [ 2 ]. In a Canadian interview study with ICU nurses, many stories also focused on the organizational preparedness of their institutions and concerns over their own safety [ 3 ]. Likewise, an international online survey ( n = 1416) across a broad range of healthcare workers found 37% of respondents to experience moderate or severe anxiety levels with occupation as a nurse being among the significant risk factors for higher anxiety identified by a multiple generalized linear model [ 4 ].…”

“…The burden placed on family representatives through remote communication methods was also considerable, with one study reporting anxiety and depression symptoms in 83% and 73% of family representatives, respectively [ 36 ]. Witnessing families’ grief was also identified as a trigger for nurses’ distress in a critical incident study in Canada [ 3 ].…”