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

Abstract

Aims To identify strategies used by registered nurses and non‐registered nursing care staff in overcoming barriers when providing fundamental nursing care for non‐invasively ventilated inpatients with COVID‐19. Design Online survey with open‐ended questions to collect qualitative data. Methods In August 2020, we asked UK‐based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non‐invasively ventilated patients with COVID‐19. We analysed data using Framework Analysis. Results A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non‐verbal communication with patients, using information technology to enable patients’ significant others to communicate with staff and patients, and establishing clear information‐sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self‐care and using ‘runners’ and interdisciplinary input. 3) Addressing patients’ well‐being and values required spending time with patients, acting in loco familiae , providing access to psychological and spiritual support, obtaining information about patients’ wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks. Conclusions Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well‐being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing. Impact As these strategies are unlikely to be exclusive to the COVID‐19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.

‘No more heroes’: The ILC Oxford Statement on fundamental care in times of crises

“…Evidence shows that missed fundamental care (also called basic nursing or essential care), including physical, psychosocial and relational elements, compromises patient safety, care quality and patient experience (Kitson et al, 2019;Richards et al, 2018) and this has been amplified during the COVID-19 pandemic (Sugg et al, 2021(Sugg et al, , 2022. There are multiple reasons for missed nursing care and in particular missed fundamental care, including workforce and economic constraints (Raso et al, 2021), which will intensify as the shortage of nurses persists (Registered Nurses' Association of Ontario, 2021).…”

“…As we recover from the pandemic, a focus on nursing retention and the profession's ability to provide quality patient care is paramount given nurses represent the largest global healthcare workforce providing direct patient care (Stemmer et al, 2022). Now more than ever, there is a pressing need for nursing leaders across research, education, clinical practice and policy to influence a humane, compassionate evidence-informed approach by focusing on restoring fundamental care as part of the organizational mandate (Richards et al, 2021;Sugg et al, 2021Sugg et al, , 2022.…”

“…Professor David Richards and colleagues' large randomized controlled trial evaluating a COVID clinical guideline across 14 hospitals in England (Richards et al, 2021;Sugg et al, 2021Sugg et al, , 2022 confirmed that essential physical, emotional and relational aspects of fundamental care were often left unattended. Video evidence of a patient's lived experience, provided via the work of Professor Richards and his team, demonstrated that some patients with COVID felt that nurses overestimated patients' ability to self-care, and patients suffered as a result.…”

The psychological experience of nursing students in their internship year during the COVID‐19 pandemic in Saudi Arabia

“…At the height of the pandemic, clinical experience and challenges in internships differed from the theoretical knowledge taught in the classroom setting. The high rates of infection of COVID-19 and the lack of standard clinical practice in managing the condition challenged nursing practices, such as using evidence-based medicine (Sugg et al, 2022).…”

Leadership for fundamental care: The whole is greater than the sum of the parts

“…Healthcare and nursing leaders cannot ignore the impact of the COVID pandemic. Several papers have described how this was undertaken (Amaral et al, 2022; Sugg et al, 2022; Schroberer et al, 2022) and how leadership interventions shaped patients' experiences of fundamental care during the pandemic. Contributions from around the globe have ranged from discursive pieces to descriptive and empirical work.…”