Sugg Holly V R, Russell Anne-Marie, Morgan Leila M, Iles-Smith Heather, Richards David A, Morley Naomi, Burnett Sarah, Cockcroft Emma J, Thompson Coon Jo, Cruickshank Susanne, Doris Faye E, Hunt Harriet A, Kent Merryn, Logan Philippa A, Rafferty Anne Marie, Shepherd Maggie H, Singh Sally J, Tooze Susannah J, Whear Rebecca
College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
School of Health and Society, University of Salford, Allerton Building, Frederick Rd, Salford, M6 6PU, UK.
BMC Nurs. 2021 Nov 1;20(1):215. doi: 10.1186/s12912-021-00746-5.
Patient experience of nursing care is associated with safety, care quality, treatment outcomes, costs and service use. Effective nursing care includes meeting patients' fundamental physical, relational and psychosocial needs, which may be compromised by the challenges of SARS-CoV-2. No evidence-based nursing guidelines exist for patients with SARS-CoV-2. We report work to develop such a guideline. Our aim was to identify views and experiences of nursing staff on necessary nursing care for inpatients with SARS-CoV-2 (not invasively ventilated) that is omitted or delayed (missed care) and any barriers to this care.
We conducted an online mixed methods survey structured according to the Fundamentals of Care Framework. We recruited a convenience sample of UK-based nursing staff who had nursed inpatients with SARS-CoV-2 not invasively ventilated. We asked respondents to rate how well they were able to meet the needs of SARS-CoV-2 patients, compared to non-SARS-CoV-2 patients, in 15 care categories; select from a list of barriers to care; and describe examples of missed care and barriers to care. We analysed quantitative data descriptively and qualitative data using Framework Analysis, integrating data in side-by-side comparison tables.
Of 1062 respondents, the majority rated mobility, talking and listening, non-verbal communication, communicating with significant others, and emotional wellbeing as worse for patients with SARS-CoV-2. Eight barriers were ranked within the top five in at least one of the three care areas. These were (in rank order): wearing Personal Protective Equipment, the severity of patients' conditions, inability to take items in and out of isolation rooms without donning and doffing Personal Protective Equipment, lack of time to spend with patients, lack of presence from specialised services e.g. physiotherapists, lack of knowledge about SARS-CoV-2, insufficient stock, and reluctance to spend time with patients for fear of catching SARS-CoV-2.
Our respondents identified nursing care areas likely to be missed for patients with SARS-CoV-2, and barriers to delivering care. We are currently evaluating a guideline of nursing strategies to address these barriers, which are unlikely to be exclusive to this pandemic or the environments represented by our respondents. Our results should, therefore, be incorporated into global pandemic planning.
患者的护理体验与安全、护理质量、治疗结果、成本及服务利用相关。有效的护理包括满足患者基本的身体、人际关系及心理社会需求，而这些需求可能因新型冠状病毒（SARS-CoV-2）带来的挑战而受到影响。目前尚无针对感染SARS-CoV-2患者的循证护理指南。我们报告了制定此类指南的相关工作。我们的目的是确定护理人员对感染SARS-CoV-2（非侵入性通气）住院患者必要护理的看法和体验，这些护理被遗漏或延迟（护理缺失）以及实施此类护理的任何障碍。
我们根据护理基本框架进行了一项在线混合方法调查。我们招募了一个便利样本，即曾护理过非侵入性通气的感染SARS-CoV-2住院患者的英国护理人员。我们要求受访者对他们在15个护理类别中满足SARS-CoV-2患者需求的能力与非SARS-CoV-2患者相比进行评分；从护理障碍列表中进行选择；并描述护理缺失及护理障碍的示例。我们对定量数据进行描述性分析，对定性数据使用框架分析法，将数据整合到并排比较表中。
在1062名受访者中，大多数人认为SARS-CoV-2患者在活动能力、交谈与倾听、非语言沟通、与重要他人沟通以及情绪健康方面情况较差。在三个护理领域中至少有一个领域，八个障碍被排在前五位。这些障碍（按排名顺序）为：穿戴个人防护装备、患者病情严重程度、不穿戴和脱下个人防护装备就无法将物品带入和带出隔离病房、缺乏与患者相处的时间、缺乏专科服务（如物理治疗师）的参与、对SARS-CoV-2缺乏了解、库存不足以及因害怕感染SARS-CoV-2而不愿与患者相处。
我们的受访者确定了感染SARS-CoV-2患者可能被遗漏的护理领域以及提供护理的障碍。我们目前正在评估一项护理策略指南，以解决这些障碍，这些障碍不太可能仅局限于此次大流行或我们受访者所代表的环境。因此应将我们的结果纳入全球大流行规划中。
