Caring Futures Institute, Flinders University, Adelaide; Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Australia.
Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Intensive Crit Care Nurs. 2024 Feb;80:103555. doi: 10.1016/j.iccn.2023.103555. Epub 2023 Oct 12.
To critically synthesis the qualitative literature to understand the experiences of critical care nurses during the COVID-19 pandemic.
A meta-aggregation systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant online databases were searched using a wide range of keywords and subject headings. All qualitative studies were included to understand the lived experiences of critical care nurses in the intensive care unit during the COVID-19 pandemic. All studies were screened using a pre-eligibility screening criteria by three reviewers. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research was used to provide methodological appraisal. The JBI method of meta-aggregation was used to extract, synthesize, and categorise the data.
17 publications met the inclusion criteria. 136 individual findings were extracted, which were synthesised into 18 categories and eight synthesised findings. The eight synthesised findings included,1) Working as a team to adapt to the challenges of the pandemic, 2) Striving to provide patient centred care, 3) Coping with frequent deaths in the intensive care unit, 4) Challenges of supporting patients family from a distance, 5) The psychological impact of caring for critically unwell patients with COVID-19, 6) Working through the challenges of the intensive care unit setting during the pandemic, 7) The challenges of wearing personal protective equipment while undertaking patient care, 8) The impact of working in the intensive care unit during the pandemic on life at home..
This qualitative systematic review has given new insight into the lived experiences of critical care nurses. There were significant psychological and physical impacts on critical care nurses working during the COVID-19 pandemic. Therefore, improving psychological support, maintaining adequate staffing levels/skill mix to ensure basic nursing care can be completed, and the attendance of leadership/management staff is essential to ensure the retention of critical care nurses and achieve optimal patient outcomes.
This review has highlighted implications for staff retention (counselling, skills development, contingency staffing), the need for improved management/leadership strategies and human resource policies to support critical care nurses when hospitals are in crisis. Additionally, the presence and needs of the family members of critically unwell patients' needs to be prioritised in the intensive care unit.
批判性地综合定性文献，了解 COVID-19 大流行期间重症监护护士的体验。
根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，进行元聚合系统评价。使用广泛的关键词和主题词搜索相关在线数据库。纳入所有定性研究，以了解 COVID-19 大流行期间重症监护病房护士的真实体验。三名审查员使用预先确定的筛选标准筛选所有研究。使用 Joanna Briggs 研究所 (JBI) 定性研究批判性评价清单对方法学进行评估。使用 JBI 元聚合方法提取、综合和分类数据。
17 篇出版物符合纳入标准。提取了 136 项个体发现，综合为 18 个类别和 8 个综合发现。这 8 个综合发现包括：1）团队合作以适应大流行的挑战，2）努力提供以患者为中心的护理，3）应对重症监护病房中频繁死亡，4）远程支持患者家属的挑战，5）护理 COVID-19 重症患者的心理影响，6）在大流行期间应对重症监护病房环境的挑战，7）在进行患者护理时穿戴个人防护设备的挑战，8）在大流行期间在重症监护病房工作对家庭生活的影响。
这项定性系统评价使人们对重症监护护士的真实体验有了新的认识。在 COVID-19 大流行期间工作的重症监护护士在心理和身体上都受到了重大影响。因此，改善心理支持、保持充足的人员配备水平/技能组合以确保完成基本护理、以及领导/管理层人员的出勤对于确保重症监护护士的留用和实现最佳患者结果至关重要。
本综述强调了人员保留（咨询、技能发展、应急人员配备）的意义，需要改进管理/领导策略和人力资源政策，以在医院面临危机时为重症监护护士提供支持。此外，重症监护病房中需要优先考虑病危患者家属的存在和需求。
