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1.
Death, grief and loss in the context of COVID-19 ; : 101-120, 2022.
Article in English | APA PsycInfo | ID: covidwho-1898099

ABSTRACT

This chapter aims to delineate issues pertaining to the unique nature of decision-making in the COVID-19 pandemic situation. Theories and literature are presented in relation to decision-making, core principles of shared decision-making and how patient conditions affect decision making processes, framing these within a healthcare utilisation context. A description of best principles for practice is outlined, alongside description of the nuanced nature of decision-making and the complexity of end-of-life decisions in a pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

2.
Intensive Crit Care Nurs ; 72: 103264, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1851181

ABSTRACT

OBJECTIVE: To gain perspectives from family members about barriers and facilitators to virtual visit set up and conduct across intensive care unit settings in the United Kingdom to inform understanding of best practices. METHODS: We conducted a qualitative descriptive study recruiting a purposive sample of family members of adult intensive care unit patients experiencing virtual visiting during Jan to May 2021 of the COVID-19 pandemic. We used semi-structured qualitative interviews and a standard Thematic Analysis approach. RESULTS: We recruited 41 family-member participants from 16 hospitals in the United Kingdom. Facilitators to successful virtual visit set-up were preparation of the family, negotiating a preferred time, and easy-to-use technology. Facilitators to successful conduct were intensive care unit team member presence; enabling family involvement in care; inclusivity, accessibility, and flexibility; and having a sense of control. Barriers that created distress or conflict included restrictive virtual visiting practices; raising expectations then failing to meet them; lack of virtual visit pre-planning; and failing to prepare the patient. Barriers to visit conduct were incorrect camera positioning, insufficient technical and staff resources, issues with three-way connectivity, and lack of call closure. Recommendations included emotional self-preparation, increased technology availability, and preparing conversation topics. CONCLUSION: These data may guide virtual visiting practices during the ongoing pandemic but also to continue virtual visiting outside of pandemic conditions. This will benefit family members suffering from ill health, living at a distance, unable to afford travel, and those with work and care commitments, thereby reducing inequities of access and promoting family-centered care.


Subject(s)
COVID-19 , Adult , Critical Care/psychology , Family/psychology , Humans , Pandemics , Qualitative Research
3.
BMJ Open ; 12(4): e055679, 2022 04 29.
Article in English | MEDLINE | ID: covidwho-1832448

ABSTRACT

OBJECTIVE: To understand the experiences and perceived benefits of virtual visiting from the perspectives of intensive care unit (ICU)-experienced clinicians and non-ICU-experienced family liaison team members. DESIGN: Qualitative descriptive study. SETTING: Adult intensive care setting across 14 hospitals within the UK National Health Service. PARTICIPANTS: ICU-experienced clinicians and non-ICU-experienced family liaison team members deployed during the first wave of the COVID-19 pandemic. METHODS: Semistructured telephone/video interviews were conducted with ICU clinicians. Analytical themes were developed inductively following a standard thematic approach, using 'family-centred care' and 'sensemaking' as sensitising concepts. RESULTS: We completed 36 interviews, with 17 ICU-experienced clinicians and 19 non-ICU-experienced family liaison team members. In the context of inperson visiting restrictions, virtual visiting offered an alternative conduit to (1) restoring the family unit, (2) facilitating family involvement, and (3) enabling sensemaking for the family. Virtual visits with multiple family members concurrently and with those living in distant geographical locations restored a sense of family unit. Family involvement in rehabilitation, communication and orientation activities, as well as presence at the end of life, highlighted how virtual visiting could contribute to family-centred care. Virtual visits were emotionally challenging for many family members, but also cathartic in helping make sense of their own emotions and experience by visualising their relatives in the ICU. Being able to see and interact with loved ones and their immediate care providers afforded important cues to enable family sensemaking of the ICU experience. CONCLUSIONS: In this UK qualitative study of clinicians using virtual ICU visiting, in the absence of inperson visiting, virtual visiting was perceived positively as an alternative that promoted family-centred care through virtual presence. We anticipate the perceived benefits of virtual visiting may extend to non-pandemic conditions through improved equity and timeliness of family access to the ICU by offering an alternative option alongside inperson visiting.


Subject(s)
COVID-19 , Adult , Critical Care/psychology , Humans , Intensive Care Units , Pandemics , State Medicine
4.
J Adv Nurs ; 2022 Mar 17.
Article in English | MEDLINE | ID: covidwho-1752586

ABSTRACT

AIMS: This discursive paper draws on three key leadership theories with the aim of outlining how styles of leadership impact the provision of fundamentals of care. DESIGN: Discussion paper. DATA SOURCES: key leadership theories, leadership and fundamentals of care literature. IMPLICATIONS FOR NURSING: The conceptualization of fundamentals of care is viewed through the lens of nursing leadership, and collective, compassionate and transformational leadership theory. The cognitive dissonance that nursing leaders encounter when trying to reconcile organizational, patient and nurses' needs is considered, and the pressure to deliver high-quality fundamentals of care presents a challenge to nurse leaders. CONCLUSION: Leaders must align nursing and patient outcome data to drive forward and prioritize fundamental care. Focusing on key elements of relational leadership styles will ensure a workforce fit to provide fundamental care, which in the current climate must be an organizational and global nursing priority. IMPACT: This discussion attempts to draw together overlapping leadership theories, emphasizes the importance of relational leadership in ensuring the provision of the fundamentals of care and acknowledged the impact of the COVID-19 pandemic on nurses and nursing care, with leadership implications outlined, such as a need for role-modelling, understanding shared values and giving nurses a voice. It will have an impact on nurse leaders, but also on those nurses providing direct care by issuing a challenge for them to confront their own nurse leaders, and to ask that they better resolve competing needs of both the nursing workforce and patients.

5.
PLoS One ; 17(3): e0264971, 2022.
Article in English | MEDLINE | ID: covidwho-1742014

ABSTRACT

BACKGROUND: Families of intensive care unit (ICU) decedents are at increased risk of experiencing complicated grief. However, factors associated with complicated grief in ICU and bereavement needs assessment are not available routinely. We aimed to conduct a systematic review identifying risk factors associated with complicated grief among family members of ICU decedents. MATERIALS AND METHODS: MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and Web of Science were searched to identify relevant articles. Observational studies and randomised and non-randomised controlled trials were included. Studies were screened and quality appraised in duplicate. Risk of bias was assessed using Newcastle-Ottawa Scale. A narrative synthesis was undertaken. RESULTS: Seven studies conducted across three continents were eligible. Four studies were of high quality. 61 risk factors were investigated across the studies. Factors associated with a decreased risk of complicated grief included age, patient declining treatment and involvement in decision-making. Factors associated with increased risk included living alone, partner, dying while intubated, problematic communication, and not having the opportunity to say goodbye. CONCLUSION: This systematic review has identified risk factors which may help identify family members at increased risk of complicated grief. Many of the studies has small sample sizes increasing the risk of erroneously reporting no effect due to type II error. Some factors are specific to the ICU setting and are potentially modifiable. Bereavement services tailored to the needs of bereaved family members in ICU settings are required. (PROSPERO registration ID 209503).


Subject(s)
Bereavement , Grief , Family , Humans , Intensive Care Units , Risk Factors
6.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-317336

ABSTRACT

Background: The COVID-19 pandemic and ensuing healthcare crisis presented staff working in critical care with unprecedented demands. We sought to understand frontline staff’s experiences of working in critical care in the UK during the first wave of the outbreak.Methods: Between August and October 2020, we conducted qualitative, semi-structured telephone interviews with forty NHS staff who worked in critical care during the first wave of the pandemic in the UK. Staff were recruited from four hospitals and included doctors, nurses, allied health professionals and ward clerks. We purposefully sought the experiences of trained and experienced critical care staff and those who were redeployed. We analysed the data using Rapid Analysis and subsequently interpreted the findings using Baehr’s sociological lens of ‘communities of fate’.Findings: COVID-19 presented staff with a situation of extreme stress, duress and social emergency, leading to a shared set of experiences which we have characterised as a community of fate. This involved fear and dread of working in critical care, but also a collective sense of duty and vocation. Caring for patients and families involved changes to usual ways of working, revolving around: reorganisation of space and personnel, personal protective equipment, lack of evidence for treating COVID-19, inability for families to be physically present, and the trauma of witnessing extreme patient acuity and death on a large scale. The stress and isolation of working in critical care during COVID-19 was mitigated by strong teamwork, camaraderie, pride and fulfilment.Interpretation: COVID-19 has changed working practices in critical care and profoundly affected staff physically, mentally and emotionally. Attention needs to be paid to the social and organisational conditions in which individuals work, addressing both practical resourcing and the interpersonal dynamics of critical care provision.Funding: Medical Research Scotland, Wellcome TrustDeclaration of Interests: CM reports a grant from Medical Research Scotland during the conduct of the study;SH reports a grant from Florence Nightingale Foundation, outside the submitted work;SS reports grants from Wellcome Trust, during the conduct of the study;CMC, AD and NP declare no competing interests.Ethics Approval Statement: Ethical approval was granted by the University of Edinburgh School of Social and Political Science Research Ethics Committee;HRA approval (20/HRA/3270) was also obtained.

8.
J Adv Nurs ; 78(4): 1075-1088, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1522730

ABSTRACT

AIMS: To understand how COVID-19 affected nurse staffing in intensive care units (ICUs) in England, and to identify factors that influenced, and were influenced by, pandemic staffing models. DESIGN: Exploratory qualitative study. METHODS: Semi-structured, online interviews conducted July-September 2020 with regional critical care leaders including policy leads (n = 4) and directors/lead nurses (n = 10) across critical care networks in England. FINDINGS: The six themes emerging from the framework analysis illustrate how the pre-pandemic ICU culture influenced ICU staffing models during the pandemic. Changes in staffing impacted on the workforce and the care delivered, whilst it was necessary to learn from, and adjust to, a rapidly changing situation. Variation across and between networks necessitated variation in responses. The overwhelming outcome was that the pandemic has challenged the central tenets of ICU nurse staffing. CONCLUSIONS: Pandemic nurse staffing models resulted in changes to ICU skill-mix and staffing numbers. Factors such as the impact of nurse staffing on care practices and on the workforce need to be taken into account when developing and testing future nurse staffing models for ICU. The extent to which ICUs will return to former staffing models is not yet known but there seems to be an appetite for change. IMPACT: In common with many countries, nurse staffing in English ICUs was adapted to address surge requirements during the COVID-19 pandemic. Findings highlight the challenge COVID-19 presented to pre-pandemic ICU nurse staffing guidelines, the impact on patient and staff well-being and the potential legacy for future staffing models. Study findings have implications for ICU nurse managers, researchers and policy makers: nurse staffing models need to be adaptable to the local context of care and future research should investigate the impact of different models on patients, staff and health service outcomes.


Subject(s)
COVID-19 , Nursing Staff, Hospital , COVID-19/epidemiology , Critical Care , Humans , Intensive Care Units , Pandemics , Personnel Staffing and Scheduling , SARS-CoV-2 , Workforce
9.
Ann Am Thorac Soc ; 18(10): 1685-1692, 2021 10.
Article in English | MEDLINE | ID: covidwho-1448592

ABSTRACT

Rationale: Restriction or prohibition of family visiting intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic poses substantial barriers to communication and family- and patient-centered care. Objectives: To understand how communication among families, patients, and the ICU team was enabled during the pandemic. The secondary objectives were to understand strategies used to facilitate virtual visiting and associated benefits and barriers. Methods: A multicenter, cross-sectional, and self-administered electronic survey was sent (June 2020) to all 217 UK hospitals with at least one ICU. Results: The survey response rate was 54%; 117 of 217 hospitals (182 ICUs) responded. All hospitals imposed visiting restrictions, with visits not permitted under any circumstance in 16% of hospitals (28 ICUs); 63% (112 ICUs) of hospitals permitted family presence at the end of life. The responsibility for communicating with families shifted with decreased bedside nurse involvement. A dedicated ICU family-liaison team was established in 50% (106 ICUs) of hospitals. All but three hospitals instituted virtual visiting, although there was substantial heterogeneity in the videoconferencing platform used. Unconscious or sedated ICU patients were deemed ineligible for virtual visits in 23% of ICUs. Patients at the end of life were deemed ineligible for virtual visits in 7% of ICUs. Commonly reported benefits of virtual visiting were reducing patient psychological distress (78%), improving staff morale (68%), and reorientation of patients with delirium (47%). Common barriers to virtual visiting were related to insufficient staff time, rapid implementation of videoconferencing technology, and challenges associated with family members' ability to use videoconferencing technology or access a device. Conclusions: Virtual visiting and dedicated communication teams were common COVID-19 pandemic innovations addressing the restrictions to family ICU visiting, and they resulted in valuable benefits in terms of patient recovery and staff morale. Enhancing access and developing a more consistent approach to family virtual ICU visits could improve the quality of care, both during and outside of pandemic conditions.


Subject(s)
COVID-19 , Pandemics , Communication , Critical Care , Cross-Sectional Studies , Family , Humans , Intensive Care Units , SARS-CoV-2 , United Kingdom
10.
Nurse Educ Pract ; 56: 103186, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1401742

ABSTRACT

AIM/OBJECTIVE: To record and learn from the experiences of students working on clinical placement in a pandemic. BACKGROUND: In March of 2020, final and second year student nurses in England were given the option to join the Covid-19 pandemic work-force, paid as high-level health care assistants. METHODS/DESIGN: Using qualitative methods and rapid analysis techniques, this study gathered the unique experiences of 16 final year students, from all fields of nursing at a University in the East of England, who chose to complete their final extended placement in a diverse range of clinical placements at the height of the first wave of the pandemic. Data was collected between July and September 2020. RESULTS: Five key themes were identified across our data: rationale for undertaking the extended placement, role tensions, caring for patients and their families, the impact on teaching and learning, and personal health and wellbeing. CONCLUSIONS: While our participants reported largely positive experiences including a perceived heightened preparedness for qualification, their experiences provide important insights for nurse educators for the education and support of future students going into similar situations, in particular relating to welfare and support, preparation for placement, resilience, e-learning and learning on the front line.


Subject(s)
COVID-19 , Education, Nursing, Baccalaureate , Nurses , Students, Nursing , Humans , Pandemics , Qualitative Research , SARS-CoV-2
11.
BMJ Open ; 11(5): e048124, 2021 05 18.
Article in English | MEDLINE | ID: covidwho-1234303

ABSTRACT

OBJECTIVE: To understand National Health Service (NHS) staff experiences of working in critical care during the first wave of the COVID-19 pandemic in the UK. DESIGN: Qualitative study using semistructured telephone interviews and rapid analysis, interpreted using Baehr's sociological lens of 'communities of fate'. PARTICIPANTS: Forty NHS staff working in critical care, including 21 nurses, 10 doctors and advanced critical care practitioners, 4 allied health professionals, 3 operating department practitioners and 2 ward clerks. Participants were interviewed between August and October 2020; we purposefully sought the experiences of trained and experienced critical care staff and those who were redeployed. SETTING: Four hospitals in the UK. RESULTS: COVID-19 presented staff with a situation of extreme stress, duress and social emergency, leading to a shared set of experiences which we have characterised as a community of fate. This involved not only fear and dread of working in critical care, but also a collective sense of duty and vocation. Caring for patients and families involved changes to usual ways of working, revolving around: reorganisation of space and personnel, personal protective equipment, lack of evidence for treating COVID-19, inability for families to be physically present, and the trauma of witnessing extreme patient acuity and death on a large scale. The stress and isolation of working in critical care during COVID-19 was mitigated by strong teamwork, camaraderie, pride and fulfilment. CONCLUSION: COVID-19 has changed working practices in critical care and profoundly affected staff physically, mentally and emotionally. Attention needs to be paid to the social and organisational conditions in which individuals work, addressing both practical resourcing and the interpersonal dynamics of critical care provision.


Subject(s)
COVID-19 , Critical Care , Humans , Pandemics , Qualitative Research , SARS-CoV-2 , State Medicine , United Kingdom
12.
J Adv Nurs ; 76(10): 2447-2449, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-437163
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