Impact of COVID‐19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: systematic review

Abstract

Aim This systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care. Design Systematic review. Data Sources In July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID‐19 Database ( https://search.bvsalud.org/ ) MedRxiv ( https://www.medrxiv.org/ ), bioRxiv ( https://www.biorxiv.org/ ) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards. Review Methods We included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID‐19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non‐professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person. Results Of 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub‐themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership. Conclusion To prepare for continuation of the COVID‐19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence‐based care to be provided in future. Impact Our review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.

Nurses’ strategies for overcoming barriers to fundamental nursing care in patients with COVID‐19 caused by infection with the SARS‐COV‐2 virus: Results from the ‘COVID‐NURSE’ survey

“…These reports mirror findings from our own systematic review on fundamental nursing care in pandemic situations, where we identified wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges as barriers to care (Whear et al, 2022 ). Our review demonstrated the poor quality of research on pandemic nursing practice with only 19 empirical articles in 64 included papers covering five pandemics.…”

“…Our results make a substantial contribution to the disappointingly scant existing empirical literature on fundamental nursing care in a pandemic, reviewed in (Whear et al, 2022 ). Of the 12 previous qualitative studies in this area, most are very small and report nurses’ experiences of care, not their adaptive strategies.…”

“…Few studies focus on patient experience or outcomes. Although many COVID‐19 resources now exist, for example staff well‐being (The Kings Fund, 2021 ), infection control (Gould & Purssell, 2021 ) and oxygen management (Messer et al, 2021 ), fundamental nursing care has not been the focus of guidelines (Whear et al, 2022 ). To prepare for the continuation of the COVID‐19 pandemic and future pandemics, the effectiveness of these strategies for meeting patients’ fundamental care must be evaluated.…”

“…In our survey of 1062 UK nursing staff caring for inpatients with COVID‐19, respondents rated their ability to meet patients’ needs in many fundamental areas of nursing care as worse for hospitalized patients with COVID‐19 than for other patients (Sugg et al, 2021 ), acknowledging that care for these patients was being missed more frequently than in other clinical situations. In a parallel systematic review of 64 articles on fundamental nursing care in five pandemics, we synthesized reports on nursing strategies used to address barriers to care (Whear et al, 2022 ), but found that the literature was mostly non‐empirical, of poor quality and provided little robust guidance to nurses. To design and test a fundamental care nursing protocol for non‐invasively ventilated inpatients with COVID‐19 (Richards et al, 2021 ), we also asked nurses experienced in caring for these patients what they did to reduce the potential for missed care.…”

“…Consequently, we designed the COVID‐NURSE fundamental nursing care clinical protocol for patients hospitalized with COVID‐19 not invasively ventilated for evaluation in a cluster randomized controlled trial (Richards et al, 2021 ) using data from i) a survey of nurses’ experiences of caring for patients with COVID‐19, including the barriers encountered in delivering fundamental care (reported elsewhere, Sugg et al, 2021 ) and strategies adopted to overcome these (reported here); ii) a systematic review (Whear et al, 2022 ); and iii) co‐creation workshops involving patients with experience of hospitalization with COVID‐19 and nurses caring for them.…”