COVID-NURSE: 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. We identified that no international evidence-based guidelines existed for nursing hospitalised patients with COVID-19, leading to potential variations in patient experience, treatment outcomes, care quality and costs.

A large national collaboration between PenARC and 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, obtained 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 continue to support the involvement of patients in all elements of the project, ensuring 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 undertook 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 was 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 undertook 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 also included review articles, commentaries, study reports, case studies, protocols and guidance documents. We used 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 and resulted in a number of related publications which follow below. Further publications are pending.

A video of a recent seminar, “Tales, trials and tribulations from the NIHR-funded COVID-NURSE cluster randomised controlled trial of fundamental nursing care for people hospitalised with the SARS-COV-2 virus” is available here