Impact of COVID-19 and other conditions requiring isolation on the provision of fundamental nursing care in hospital

Background

Patient experience of care is connected with safety, clinical effectiveness, care quality, treatment outcomes and reduced overall service use. Currently, no international evidence-based guidelines exist for nursing hospitalised patients with COVID-19. This can lead to potential variations in patient experience, treatment outcomes, care quality and costs.

A large national collaboration between the universities of Exeter, Leicester, Nottingham, Southampton and King’s College London, as well as the Royal Devon and Exeter NHS Foundation Trust and NHS Trusts in Leeds, London and Nottingham, and with the NIHR Applied Research Collaboration (ARC) South West Peninsula were recently successful in obtaining funds to undertake the first national clinical trial of nursing care for patients infected with the SARS-COV-2 virus.

Professor David Richards, Chief Investigator said:

“Nurses are critical to patient experience and care. Nurses help people with eating, drinking, going to the toilet, skin care, moving, keeping clean, breathing, communication and mental wellbeing. We know many nurses have risen to the complex challenges of caring for people with COVID-19 in innovative ways. This study will help us establish what has proved effective, so that innovations that benefit patients can be rolled out to the global nursing community.”

Our Patient and Public Involvement team have been supporting the involvement of patients in all elements of the project to ensure that the patient perspective is at the heart of the research.  As part of the intervention development phase of the trial, our Evidence Synthesis Team are undertaking a systematic review of the impact of COVID-19, and other conditions requiring isolation, on the provision of fundamental nursing care and the techniques required by nurses caring for these patients.

Aims

Our aim with the systematic review is to identify, appraise and synthesise the evidence for:

• The impact of COVID-19 and other conditions requiring isolation on the provision of fundamental nursing care to patients in hospital, and
• The effectiveness of adaptations to overcome these barriers in terms of overall patient experience, care quality, functional ability and treatment outcomes.

Research Questions

1. What is the impact of SARS-COV-2 and other conditions requiring isolation on the provision of fundamental nursing care to patients with SARS-COV-2 in hospital?
2. How have adaptations to fundamental nursing care practices as a result of SARS-COV-2 and other conditions requiring isolation impacted overall patient experience, care quality, functional ability and treatment outcomes for patients with SARS-COV-2 in hospital?
3. What are the key themes of published protocols and guidance for the provision of fundamental nursing care for patients with SARS-COV-2 in hospital?

We defined fundamental nursing care as: physical care including personal cleansing (including oral/mouth care) and dressing, toileting needs, eating and drinking, rest and sleep, mobility, comfort (pain management, breathing easily, temperature control), safety (risk assessment and management, infection prevention, minimising complications), medication management and relational care including establishing a relationship with patients, talking and listening to patients, non-verbal communication with patients, shared decision making with patients, communicating with patients’ relatives, carers and significant others, dignity and respect needs, respecting values and beliefs, emotional wellbeing and anxiety and low mood.

Project Activity

We are undertaking a systematic review of any quantitative or qualitative study reporting i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID-19, MERS, SARS, H1N1 or Ebola Virus Disease (EVD) and ii) the views, perceptions and experiences of professional nurses and health care assistants who have provided that care. In addition to reports of empirical studies, we are also including review articles, commentaries, study reports, case studies, protocols and guidance documents. We are using a range of critical appraisal tools suitable for the variety of study designs and conducting a thematic synthesis based on barriers to providing fundamental care and adaptations developed to overcome these.

Findings from the review have fed into a series of consensus meetings as part of the development of the intervention for the clinical trial.

We are currently drafting a publication for submission to a peer reviewed journal – more details will be available soon.

Related publications

More details of the methods we used in the systematic review are available in our protocol.

More details on the clinical trial are available on the dedicated trial website.

Outputs

Professor David Richards, NIHR Senior Investigator Emeritus and Professor of Mental Health Services Research at the University of Exeter has written a blog called Learning from the experience of nurses to deliver the best care for COVID patients.

Richards DA, Sugg HV, Cockcroft E, et al COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus—protocol for a cluster randomised controlled trial BMJ Open 2021;11:e046436. doi: 10.1136/bmjopen-2020-046436