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

Abstract

ObjectivesIntensive Care Unit (ICU) nurses are at the forefront of fighting and treating the Coronavirus 2019 (COVID-19) pandemic and are often directly exposed to this virus and at risk of disease, due to their direct care for infected patients. This study aims to synthesize the experiences of ICU nurses working with COVID-19 patients.MethodsA systematic review and meta-synthesis of qualitative studies were undertaken. A systematic literature search in four databases, including Web of Sciences, Scopus, Embase, and PubMed (including Medline), was performed. Original qualitative studies and the qualitative section of mixed method studies, written in English, which focused on the experiences of only ICU nurses working with COVID-19 patients, were included.ResultsSeventeen qualitative studies and two mixed-method studies were included in the review. As a result of the inductive content analysis, six main categories were identified, as follows: “distance from holistic nursing,” “psychosocial experiences,” “efforts for self-protection and wellbeing,” “organizational inefficiency,” “job burnout,” and “emerging new experiences in the workplace.”ConclusionsThe findings from this study suggest that healthcare authorities and policymakers can facilitate the provision of high-quality patient care during the COVID-19 pandemic through appropriate planning to provide adequate support and training, prevent shortages of nursing staff and equipment, and provide adequate attention to the psychological needs and job satisfaction of ICU nurses.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256070, identifier: CRD42021256070.

Redeployment to critical care during the COVID‐19 pandemic: A phenomenological study

“…The unknown nature of the disease also created uncertainty as the route of transmission and prognosis were not entirely clear in the early phase of the pandemic. 14 The study by Bergman et al 9 was conducted in Sweden and identified one of its themes as 'tumbling into chaos'. This theme describes how many of the nurses working during the pandemic found themselves in a chaotic and surreal environment through the creation of surge capacity in operating departments as well as staff being transferred with little or no induction and training.…”

“…Uncertainty in the early stages of the pandemic is compounded by fear and anxiety among staff about becoming infected and then passing the infection on to family members. 14,15 Over time staff adapt to the challenges presented by the pandemic and, in a wide-ranging meta-synthesis exploring nurses' psychological experiences, Han et al 15 found staff gradually adapted to the work and became more confident in managing critically ill patients with COVID-19.…”

“…In addition, some procedures were either not performed as frequently as before or not performed for the same duration to reduce the infection risk (Han et al 2022) In addition, there were changes in the nurse-patient ratio. 9 Another feature of care during the pandemic was the lack of family involvement because of the infection risk 14 and concern among nurses that care was dehumanized because of the issues around communication and personal protective equipment. 9 Similar communication concerns were identified in the review by San Juan et al 13…”

“…The redeployment of staff to critical care units from other specialisms was greeted with gratitude by some critical care core staff 9 while others described the increased workload associated with the induction of new people and the provision of day-to-day support. 14 Cadge et al 10 described how the challenges of working with new co-workers and the integration of new staff into existing teams required everyone to negotiate new relationships. Another significant issue was having to define roles for staff particularly when they lacked some of the specialist competencies of critical care staff.…”

Assessment of the Critical Care Work Environment of Intensive Care Unit Nurses in Saudi Arabia

“… 4 It has been proven that the health of the work environments of critical care nurses affects patient care outcomes and the job satisfaction and retention of registered nurses. 5 A growing body of evidence demonstrates a connection between nurse work environments and patient outcomes. 6 , 7 …”