Oxford Brookes University/Oxford University NHS Trust, Oxford, UK.
Oxford Brookes University, Oxford, UK.
J Adv Nurs. 2022 Oct;78(10):3371-3384. doi: 10.1111/jan.15419. Epub 2022 Aug 20.
To explore registered nurses' experiences of patient safety in intensive care during COVID-19.
A qualitative interview study informed by constructivism.
Semi-structured interviews were conducted and audio-recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework.
Two key themes were identified. 'On a war footing'-an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. 'Doing the best we can'-Safe Delivery of Care which describes the ramifications of the actions taken on short- and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer Support.
Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an understanding of the holistic and long-term impacts on patient safety and recovery from critical illness.
This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing workforce modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals.
探讨 COVID-19 期间重症监护病房护士对患者安全的体验。
基于建构主义的定性访谈研究。
对 2021 年 5 月至 7 月期间在 COVID-19 期间在重症监护病房工作的 19 名注册护士进行半结构式访谈，并进行录音。访谈逐字记录，并利用框架进行主题分析。
确定了两个关键主题。“处于战争状态”-描述护士所面临的情况以及为安全提供护理而采取的行动的前所未有的情况。“尽我们所能”-安全提供护理，描述了采取的行动对短期和长期患者安全的影响，包括护理组织、遗漏和次优护理以及沟通。这两个主题都嵌入在员工福利和同伴支持的背景下。
护士报告称患者安全风险增加，他们将其归因于技能组合的稀释和护理的碎片化。护士对患者安全和从重症疾病中恢复的整体和长期影响有一定的认识。
本研究从护理角度探讨了 COVID-19 对重症监护病房患者安全的影响。技能组合的稀释，即具有重症监护经验的注册护士与没有重症监护经验的注册护士混合使用，以及护理的碎片化，被认为会导致护理质量下降，不良事件增加，伤害风险增加，但这些情况并未得到一致的正式报告。此外，护士表现出对患者安全的整体和长期认识。这些发现应作为重症监护病房领导和管理人员未来护理人员建模和患者安全策略的一部分进行考虑。本研究没有公众或患者的贡献。研究目的和目标是与医疗保健专业人员合作制定的。
