Nurses' experience of an Extracorporeal Membrane Oxygentation (ECMO) clinical support team during the COVID-19 pandemic: A service evaluation.

BACKGROUND: The COVID-19 pandemic placed unprecedented stress on the National Health Service and critical care units including those with Extracorporeal Membrane Oxygenation (ECMO) facility as this intervention had proved successful with H1N1 patients in 2009. To successfully care for the influx of ECMO patients, an ECMO clinical support team (ECST) formed by redeployed staff was created to assist critical care nurses. AIM: This service evaluation aims to review the experience of critical care nursing staff working with an ECST during the period of increased provision of ECMO care. STUDY DESIGN: A UK-based single-site qualitative service evaluation was followed. METHOD: Critical care nursing staff's feedback was anonymously collected using a paper questionnaire designed for this project. Data were analysed using inductive content analysis. FINDINGS: Approximately 40 critical care nurses were invited to complete a questionnaire, 19 (48%) of whom completed it within the available timeframe. A variety of themes were identified including 'Prior knowledge of ECST', 'Management matters', 'ECST in action', 'ECST response', 'Emotions' and 'Overall experience of the ECST'. Staff initially reported apprehension regarding a new team and training responsibilities. Following the rollout of the ECST, nurses' accounts described the utilization of the ECST and subsequent stress relief. Feedback commented on the ECST's positive attitude, effective team working with the critical care team and provision of moral support. Nurses' gratitude was strongly conveyed throughout, with many expressing the positive effect of the ECST on staff emotional well-being. CONCLUSION: The implementation of the ECST provided clinical and emotional support to nurses. The ECST demonstrated the effective use of redeployed health care staff to support the critical care unit at a time of a significant increase in patients requiring ECMO. This could be used as a model to enhance staffing levels in the event of future viral outbreaks.

A qualitative analysis of suicidal psychiatric inpatients views and expectations of psychological therapy to counter suicidal thoughts, acts and deaths.

BACKGROUND: Suicide is a global problem and suicidal behavior is common in acute psychiatric wards. Inpatient suicides regularly occur with 10.4/100,000 such deaths recorded in the UK in 2016. Inpatient suicides are potentially the most avoidable of all suicides as inpatients have 24-h staff contact. Current inpatient treatment prioritizes maintenance of physical safety by observation, medication and general supportive measures, however efficacious and effective specific treatments are lacking. Psychological treatments have a growing evidence base for suicide prevention yet provision of inpatient therapy is uncommon. The present qualitative study aimed to understand the patient acceptability issues by investigating suicidal inpatients views and expectations of a novel suicide-focussed cognitive behavioural psychological therapy which was nested alongside a pilot clinical trial of the intervention. METHODS: Thematic analysis of semi-structured individual qualitative interviews with twenty suicidal psychiatric inpatients to investigate their views and expectations about ward-based suicide-focused psychological treatment. RESULTS: Two main themes were identified. The first, 'A therapy that works', revealed inpatients' views of the necessary components for effective ward-based suicide-focused psychological therapy. The second, 'Concerns about in-patient suicide-focused therapy', depicted their fears about engaging in this treatment. Results suggested that suicide-focused psychological therapy was cautiously welcomed by inpatients' whose narratives expressed their needs, priorities and concerns. Further data analysis enabled formation of a user-informed model of suicide-focussed psychological therapy which offers guidance for researchers and clinicians. CONCLUSIONS: We conclude that hospitalization of suicidal individuals offers a critical opportunity to intervene with effective treatment to preserve life and that suicide-focussed psychological therapy is likely to be well received by suicidal inpatients warranting further testing with a sufficiently powered definitive trial. It is important that provision of ward-based psychological therapy for suicidal inpatients addresses the considerable context-specific challenges inherent in this setting. TRIAL REGISTRATION NUMBER: ISRCTN 17890126 , Registry: UK Clinical Trials Gateway, Date of registration: 22/04/15, Date of enrolment of first participant to the trial: 20/05/14 (retrospectively registered).

Staff experiences and perceptions of working with in-patients who are suicidal: qualitative analysis.

BackgroundSuicidal behaviour is frequent in psychiatric in-patients and much staff time and resources are devoted to assessing and managing suicide risk. However, little is known about staff experiences of working with in-patients who are suicidal.AimsTo investigate staff experiences of working with in-patients who are suicidal.MethodQualitative study guided by thematic analysis of semi-structured interviews with mental health staff with experience of psychiatric in-patient care.ResultsTwenty staff participated. All had encountered in-patient suicide deaths or attempts. Three key themes were identified: (a) experiences of suicidality, (b) conceptualising suicidality and (c) talking about suicide.ConclusionsSuicidal behaviour in psychiatric wards has a large impact on staff feelings, practice and behaviour. Staff felt inadequately equipped to deal with such behaviours, with detrimental consequences for patients and themselves. Organisational support is lacking. Training and support should extend beyond risk assessment to improving staff skills in developing therapeutic interactions with in-patients who are suicidal.