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Exploring the experience of cardiothoracic ICU clinicians during the COVID-19 pandemic: A grounded theory study
Leah Hughes1, Benjamin Shelley2,3, Joanne McPeake4
1NHS Ayrshire and Arran, Ayr, UK.
Insights
Healthcare staff in non-COVID intensive care units experienced potentially morally injurious events due to visiting restrictions during the pandemic. This highlights the need for support for all staff, even those not directly caring for COVID-19 patients.
Area of Science:
- Critical Care Medicine
- Psychology
- Healthcare Management
Background:
- Flexible visiting policies in UK Intensive Care Units (ICUs) changed during the COVID-19 pandemic.
- COVID-19 restrictions negatively impacted patients, families, and staff, but data on non-COVID ICUs was limited.
Purpose of the Study:
- To explore the experiences of healthcare staff caring for non-COVID-19 patients in a cardiothoracic critical care unit during the pandemic.
Main Methods:
- Qualitative research using a grounded theory approach.
- Semi-structured interviews were conducted with 20 healthcare staff (nurses, doctors, allied health professionals).
- Data analysis led to the construction of a theory.
Main Results:
- Four main categories emerged: impact of visiting restrictions, patient dehumanisation, end-of-life care, and witnessing distress.
- Healthcare staff in non-COVID ICUs were exposed to potentially morally injurious events.
- A theory emerged suggesting regular exposure to such events.
Conclusions:
- Healthcare staff caring for non-COVID-19 patients during visiting restrictions faced potentially morally injurious events.
- Repeated exposure can lead to moral injury and adverse consequences.
- There is a need to support all healthcare staff in the post-COVID era, including those in non-COVID settings.
Background:
Prior to the COVID-19 pandemic a flexible approach to visiting was adopted by many Intensive Care Units in the United Kingdom. Due to the rapid spread globally of COVID-19, significant policy changes were put in place, including the restriction on visitors to patients in hospital. Evidence has emerged demonstrating the negative impact of these restrictions on patients with COVID-19, their families and the staff caring for them. However, there is limited data about the impact of these restrictions in the non-COVID ICU environment.
Aim:
This study aimed to explore the experiences of staff caring for non-COVID-19 patients in a cardiothoracic critical care unit during the COVID-19 pandemic.
Study Design:
This qualitative research study adopted a grounded theory methodological approach. This methodology was used due to the unique situation, with no prior research available. We recruited healthcare staff that worked in a cardiothoracic critical care unit during the COVID-19 pandemic. Semi structured interviews were carried out, transcribed, and analysed. Using the data collected, a theory was constructed.
Results:
Interviews were carried out with 20 healthcare staff from a range of professions including nurses, doctors, and allied health professionals. Following data analysis four main categories emerged from the data: impact and implementation of visiting restrictions; the dehumanisation of patients; end-of-life care and witnessing distress. From these four categories, a theory has emerged suggesting that healthcare staff in a non-covid ICU were regularly exposed to potentially moral injurious events, despite being shielded from caring for patients with COVID-19.
Conclusions:
This study provides a theory that healthcare staff caring for non-COVID-19 critical care patients during the period of visiting restrictions were exposed to potentially morally injurious events.
Relevance To Clinical Practice:
Repeated exposure to potentially morally injurious events can lead to the development of moral injury and its adverse consequences. This study highlights the need to support all staff in the post COVID era, including those who worked in a non-COVID environment.
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