Absttract and Introduction
Absttract
Background:The COVID-19 pandemic has challenged health care professionals, especially those working in intensive care units (ICUs).
Objectives:To explore critical care nurses' experiences with and perceptions of the COVID-19 pandemic during the early phases of the pandemic.
Methods:Data were from national surveys conducted during March and April 2020 to assess ICU providers' perceptions of the initial phases of the pandemic. A total of 831 responses from nurses to open-ended questions were examined by using thematic analysis. The questions assessed potentially limited resources in the ICU, adequacy of staffing, and measures used to reduce the possibility of spreading COVID-19 to family members.
Results:Overarching themes concerned access to equipment and preventive measures taken to reduce exposure to the virus. These themes included "sheltering the patient when I don't have enough" and "protecting those I love when I am a vector of transmission." Subthemes for the first overarching theme included not having enough personal protective equipment, not enough staff and not enough properly trained staff, and not enough institutional support. Subthemes for the second overarching theme included "isolating myself from everyone I care about" and "isolating everything I touch from everyone I care about."
Conclusions:This thematic analysis identified several concerns of ICU nurses related to caring for patients in the initial phases of the COVID-19 pandemic. Ensuring adequate supplies, staffing, and administrative and emotional support are provided to frontline health care providers during the ongoing pandemic remains essential.
Introduction
The COVID-19 pandemic has placed an unprecedented strain on the US health care system and health care professionals, especially those working in intensive care units (ICUs). In recent publications on the impact of the pandemic on clinicians, researchers have highlighted physical and psychological effects on physicians, nurses, and other frontline providers.[1–15] These reports also highlight the challenges experienced by ICU nurses as a result of caring for critically ill patients with COVID-19, such as physically demanding work, poor patient prognosis, lack of family presence, and moral distress.[6,7,9]
The ongoing pandemic has compounded the existing nursing shortage.[5] Because the largest number of health care providers are nurses, and because nurses spend the most time at the bedside, we can gather valuable information for administrators, nursing leaders, educators, and clinicians interested in mitigating impacts on the nursing workforce by identifying the impact of the COVID-19 pandemic on ICU nurses. In this thematic analysis of data from a series of rapid-cycle surveys of a national sample of more than 14 000 ICU clinicians, we explore the experiences and perceptions of critical care nurses concerning the impact of the COVID-19 pandemic during the early phases of the pandemic.
Data from national surveys conducted during the early phase of the COVID-19 pandemic were analyzed using thematic analysis to identify ICU nurses' experiences and perceptions.
Impact of the Pandemic on Critical Care Nursing Practice
Although all members of the ICU team are affected by the COVID-19 pandemic, the ability of critical care nurses to provide patient care and promote family-centered care in the ICU has been especially affected.[16–19] In an effort to collect data on the impact of the pandemic on critical care providers, the Society of Critical Care Medicine, a national organization of more than 16 000 clinicians including physicians, nurses, pharmacists, respiratory therapists, and others, launched a series of rapid-cycle surveys in March through July 2020.[4,20]
The first survey was launched March 18, 2020, through March 25, 2020, to assess ICU clinicians' perceptions of the degree to which ICU facilities and teams were prepared to treat patients with COVID-19, concerns related to caring for patients with COVID-19 in the ICU, and efforts that had been made to care for such patients.[20] The second survey was launched during a 2-week period from April 7, 2020, through April 22, 2020, to assess ICU clinicians' perceptions of the most critical ICU needs in managing the COVID-19 pandemic, challenging aspects of care, level of resources, concerns about being exposed to COVID-19, and level of personal stress.[4] The third rapid-cycle COVID-19 survey was conducted during a 3-week period in July 2020 and focused on surge capacity, including the availability of critical-care-trained staff to support pandemic response in the ICU, specific ICU staffing modifications implemented to manage the COVID-19 pandemic, and mechanical ventilation and prone-positioning practices.
A study inclusion criterion was that respondents had provided care in the ICU to a patient with confirmed or suspected COVID-19. Each survey included several open-ended questions to further assess clinicians' perceptions, which formed the basis for this thematic analysis.
Collectively, more than 14 000 critical care providers responded to the surveys. These clinicians included ICU nurses (n = 10 480, 72%), physicians (n = 899, 6%), advanced practice providers including nurse practitioners and physician assistants (n = 674, 4.6%), respiratory therapists (n = 437, 3%), and pharmacists (n = 113, 0.8%).
Because the largest number of responses to the open-ended questions were from critical care nurses, our purpose in this thematic analysis was to explore the experiences and perceptions of these nurses concerning the impact of the COVID-19 pandemic.
Am J Crit Care. 2022;31(4):275-282. © 2022 American Association of Critical-Care Nurses
