ABSTRACT
Introduction: Intensive Care Unit (ICU) design impacts staff well-being1 with relocation to a different ICU layout causing staff stress.2,3 During the COVID-19 pandemic our new critical care centre was opened expediently allowing increased patient capacity and providing a purpose-built environment for ICU patients. The new single-bed room layout differed to other open plan multi-bed ICUs in the hospital. New design features included large floor-to-ceiling windows with park views, modernised equipment such as computer screens on movable pendants and noise reduction features. The pandemic accelerated the opening of the new unit and practice was adapted to address surge conditions (e.g., there were two patients in each 'single' room, and PPE could only be worn in specific areas of the unit, restricting movement). Objectives: We sought to understand the impact of the ICU design on staff experiences during pandemic conditions. Methods: Following ethical approval, staff who had worked on the new unit were invited to participate in a semi-structured interview. The interview guide was based on the Theoretical Domains Framework (TDF),4 a framework to identify the determinants of behaviour change. Interviews were audio recorded, anonymised and transcribed verbatim. We used line-by-line coding and analysed data informed by the TDF. Results: 21 participants captured experiences of a wide range of multi-disciplinary staff members. The most common domain identified within the data was 'Environmental context and resources', including data pertaining to barriers and facilitators of the new unit to effective working: Having large bed spaces is perfect for getting people out [of bed]. They are soundproofed as well, so patients were sleeping really well at night. Also, 'social/professional role and identity' (including group identity, leadership), 'skills' (including competence, skills development), and 'beliefs about consequences' (perception of the effects of the new units) were frequently identified in positive and negative ways: .because of where it [the patient's room] is located you do not get to see people often. I got forgotten for rolls.It was a constant struggle Medical staff and allied health professionals described advantages over the old unit design including improved team-working, oversight of patients, and mood from the design features. Participants perceived patient benefits from improved lighting and views and stimulation due to access to social media. Conversely, nurse participants perceived less support, less team-working and increased levels of anxiety due to the single rooms. Nurse experiences improved as patient numbers reduced. However, changes in how nurse teams worked was an ongoing challenge: staffing breaks and things is quite tricky. You need a permanent floater that is never allocated to patients, to try and help people, because they cannot leave their bays. Conclusions: Our findings support previous research2 demonstrating increased nurses stress when transitioning to a single-bed room ICU layout. Providing systems to alleviate nurse isolation, promote teamworking and reduce stress in future relocations may significantly improve staff well-being (e.g., video-calling and messaging between patient rooms). A multidisciplinary awareness of the impact on nurses is vital to support strategies to ameliorate the impact of changes during relocation.
ABSTRACT
Introduction Gut-directed hypnotherapy is an evidence-based treatment for refractory Irritable Bowel Syndrome (IBS). Traditionally, hypnotherapy has been delivered face-to-face, but the emergence of video-technology has enabled remote delivery with comparable results1. However, data on patient experience and acceptance of remote hypnotherapy for IBS are lacking. We therefore evaluated feedback from consecutive patients that received remote hypnotherapy during enforced COVID-19 restrictions. Methods Patients with refractory IBS referred for hypnotherapy at a tertiary centre received 12-sessions of hypnotherapy remotely via Skype using the Manchester Protocol2 during COVID-19 restrictions. As part of a service evaluation, consecutive patients treated during the COVID-19 pandemic completed a 14- item feedback questionnaire on their experience and opinions following their course of remote gut-directed hypnotherapy. Results 29 patients with refractory IBS (22/29 (76%) female, 15/29 (52%) aged >41-years) completed the feedback questionnaire after receiving remote hypnotherapy during the pandemic. Overall,16/29 (55%) of patients indicated that they would have opted for remote over face-to-face hypnotherapy regardless of the pandemic situation. These preferences did not differ between those who were local, and those based >20 miles distance from the treatment centre (P=0.84). Most rated the video-technology (Skype) easy to use (25/29, 86%). The majority (25/29, 86%) reported that remote hypnotherapy improved their global IBS symptoms, with 16/29 (55%) reporting >30% overall improvement, and 6/29 (21%) reporting >50% improvement. Remote hypnotherapy also improved stress levels (26/29, 90%) and quality-of-life (24/29, 83%). However, after completing remote treatment, 15/29 (52%) felt they would have had more benefit from face-to-face hypnotherapy. The main advantages of remote hypnotherapy from a patient perspective were improved access (21/29,72%);reduced travel costs (23/29,79%) and convenience (21/ 29,72%). The main difficulties frequently encountered included: in-home interruptions (9/ 29,31%);issues with internet connectivity (9/29,31%) and difficulties logging in (9/29, 31%). However, the majority (25/29, 86%) would recommend remote hypnotherapy to a friend/relative with similar symptoms. Conclusion Remote gut-directed hypnotherapy for IBS has been well received by patients and has been effective in providing effective treatment during enforced pandemic restrictions. In the post-COVID era, these data support the need to continue to develop and optimise remote hypnotherapy, but also suggest that there may still be a role for face-to-face hypnotherapy, with patient choice being an important factor.