Building a Covid-19 secure intensive care unit: A human-centred design approach

The impact of a clinical academic nurse researcher in critical care: A 1-year service review

AIMS

To outline the activity and impact from implementing a clinical academic nurse researcher in a multi-centre critical care unit.

DESIGN

A prospective exploratory activity audit informed by the Plan, Do, Study, Act framework.

METHODS

Quantitative data on clinical academic activity, from 1 April 2023 to 31 March 2024, were collected in a Microsoft Excel © [2022, version 16.66.1] spreadsheet. Activity narratives were detailed in qualitative data and the impact categorized.

RESULTS

A total of 1500 clinical academic activity hours were logged (accounting for annual leave entitlement and sickness). Of these, 973 h were directly categorized within clinical academic activity. Most frequently undertaken clinical academic activities were academic writing (17.6%), data collection/analysis (9.6%), grant and funding workup (6.8%), Intensive Care Unit service development (6.6%), clinical activity (5.2%) and local level capability and capacity (4.9%) and other supportive tasks such as administration, unscheduled meetings, critical planning time and peer support (38%). Improvements broadly mapped onto five healthcare improvement domains; organizational, process design, data optimization and utilization, evidenced-based practice, and patients/staff impact.

CONCLUSIONS

Our data indicate system mechanisms afforded by the clinical academic role that have not been explored within the contemporary literature. A nursing clinical academic demonstrates impact across the broad organization whilst increasing the visibility of nursing work and the potential for system resilience. In conclusion, our service review underscores the transformative potential of clinical academics in shaping the future of healthcare. Utilizing their expertise and contributions paves the way for innovation, excellence and sustainability in patient care.

IMPACT

This review has provided clarity about clinical academic activity of a nurse researcher during the first year. There is international impact of this work for both clinical academics who may be evaluating such roles and healthcare management developing similar roles locally.

PATIENT AND PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Successfully initiating an escalation of care in acute ward settings-A qualitative observational study

AIMS

To address knowledge gaps by (i) developing a theoretical understanding of escalation and (ii) identifying escalation success factors.

DESIGN

Non-participant observations were used to examine deteriorating patient escalation events.

METHODS

Escalation event data were collected by a researcher who shadowed clinical staff, between February 16th 2021 and March 17th 2022 from two National Health Service Trusts. Events were analysed using Framework Analysis. Escalation tasks were mapped using a Hierarchical Task Analysis diagram and data presented as percentages, frequency and 95% CI.

RESULTS

A total of 38 observation sessions were conducted, totaling 105 h, during which 151 escalation events were captured. Half of these were not early warning score-initiated and resulted from bleeding, infection, or chest pain. Four communication phenotypes were observed in the escalation events. The most common was Outcome Focused Escalation, where the referrer expected specific outcomes like blood cultures or antibiotic prescriptions. Informative Escalations were often used when a triggering patient's condition was of low clinical concern and ranked as the second most frequent escalation communication type. General Concern Escalations occurred when the referrer did not have predetermined expectations. Spontaneous Interaction Escalations were the least frequently observed, occurring opportunistically in communal workspaces.

CONCLUSION

Half of the events were non-triggering escalations and understanding these can inform the design of systems to support staff better to undertake them. Escalation is not homogenous and differing escalation communication phenotypes exist. Informative Escalations represent an organizational requirement to report triggering warning scores and a targeted reduction of these may be organizationally advantageous. Increasing the frequency of Spontaneous Escalations, through hospital designs, may also be beneficial.

IMPACT STATEMENT

Our work highlights that a significant proportion of escalation workload occurs without a triggering early warning score and there is scope to better support these with designed systems. Further examination of reducing Informative and increasing Spontaneous Escalations is also warranted.

PATIENT AND PUBLIC CONTRIBUTION

Extensive PPIE was completed throughout the lifecycle of this study. PPIE members validated the research questions and overarching aims of the overall study. PPIE members contributed to the design of the study reviewed documents and the final data generated.

"Who Takes Care of Carers?": Experiences of Intensive Care Unit Nurses in the Acute Phase of the COVID-19 Pandemic

Introduction: The COVID-19 pandemic caused an international health emergency situation where nursing took on a fundamental role. The high number of patients in hospital ICUs led to a shift in nurses' working conditions and workload. Objective: The objective of this study was to describe the experiences of nurses who worked in ICUs during the acute phase of the COVID-19 pandemic. Methodology: A qualitative, descriptive study was carried out, with the participation of 21 nurses who worked in the ICU during the pandemic. Data collection took place between May and July 2021 through 21 in-depth interviews. Results: Three main themes emerged: (1) COVID-19 in ICUs: nurses on the frontline. (2) United against adversity: teamwork. (3) New optics of critical care and the nursing profession. COVID-19 was perceived with harshness, and the lack of knowledge about the virus generated confusion, anxiety and fear due to the risk of transmission to family members and relatives. The pandemic marked a shift in the management of human, material and economic resources. Novice nurses learned critical care at an accelerated pace, with significant physical and psychological strain. Expert nurses carried the burden of training new nurses. Although there were tense situations, experiencing these adverse situations as a team led to feelings of increased belonging, togetherness and professional bonding for nurses. While the participants noted an increase in motivation to continue in their profession, they also had a feeling of not having been cared for as they deserve by healthcare institutions.