Researchers from the University of Seville's Nursing Department, with the collaboration of professionals from the ICU at Virgen Macarena University Hospital in Seville, have analysed the key factors in caring for critical COVID-19 patients during the first wave of the pandemic. Their study concludes that nursing care was impacted by fear and isolation, which made it difficult to maintain the human experience of health care.
The break down in the humanising trend of ICU care during this period was mainly the result of the isolation of COVID-19 patients. This, along with the personal protection equipment worn by staff to prevent becoming infected themselves and the restrictions on family visits, made it more difficult to provide comprehensive and holistic care to individuals, as highlighted in the study.
Fear of the unknown, a lack of suitable protocols and adequate protective materials at the beginning of the pandemic, uncertainty in the face of an unknown and very deadly virus, together with the staff's fear of infecting their loved ones were the main feelings perceived by nurses. In fact, this situation led several of them to require psychological support and had a knock on impact on their ability to work optimally as they had up to the pandemic.
Fear of the unknown exponentially amplified negative feelings, causing emotions to emerge that they had never experienced in their working environment. Initially, the lack of material resources, personnel and protocols was a determining factor. However, as the weeks went by, management issues were overcome as greater insight was gained into the disease, leading to specific protocols being developed and implemented and improvements to the organisation of care.
To these factors, nursing professionals added the difficulty of working with nurses without specialised training in intensive care. Some of them had to join the ICU from other specialised fields as Covid-19 patient numbers rose. "Intensive care training is included in the bachelor's degree but much has to be left out for lack of time," explains Rafael-Jesús Fernández-Castillo, one of the study's authors. "We nurses fought long and hard for the intensive care specialisation. There is ample scientific evidence supporting the need for it with futile results on the part of the leaders. Therefore, better trained critical care back-up staff would have reduced the workload of the nurses in the regular team".
The study, which appeared in the journal Nursing in Critical Care, published by the British Association of Critical Care Nurses (BACCN), took a qualitative approach. To achieve its objective, 17 nurses of different ages, training and experience who worked at the ICU of Virgen Macarena University Hospital in Seville during the first wave of the pandemic (April 2020) were interviewed for the study.
Nursing in Critical Care