Evaluation of a COVID-19 fundamental nursing care guideline versus usual care: The COVID-NURSE cluster randomized controlled trial

AIM

To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID-19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health-related quality of life and cost-effectiveness.

DESIGN

Parallel two-arm, cluster-level randomized controlled trial.

METHODS

Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID-19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient-reported co-primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention-to-treat analyses.

RESULTS

We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570-572 (98.1%-98.5%) patient participants in 14 clusters. We found no evidence of between-group differences on any patient, nurse or economic outcomes. We found between-group differences over time, in favour of the intervention, for three of our five co-primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the 'other' ethnicity subgroup.

CONCLUSION

We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non-white British patients' experience of care.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required.

IMPACT

Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non-white British patients' experience of care.

REPORTING METHOD

CONSORT and CONSERVE.

PATIENT OR PUBLIC CONTRIBUTION

Patients with experience of hospitalization with COVID-19 were involved in guideline development and writing, trial management and interpretation of findings.

Assessment of Readiness Toward Flipped Learning Among Novice Nursing Students on Fundamental Nursing Care in Puducherry, South India

Background This study aimed to assess the readiness toward flipped learning (FL) among novice nursing students in fundamental nursing care in Puducherry, South India.  Methodology A cross-sectional descriptive study was conducted among 176 first-year B.Sc. Nursing students from three private nursing colleges by purposive sampling technique. In theory and practical classes, the students were taught fundamental nursing procedures such as oral medication, intramuscular injection, peripheral intravenous cannulation, and nasogastric tube feeding as FL. The study was conducted from November 2021 to March 2022. The responses were collected using the Nursing Students' Readiness for Flipped Classroom (NSR-FC) scale with four domains such as personal, technological, environmental, and pedagogical readiness. Pearson correlation and chi-square tests were used to analyze data by incorporating IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA). Results Among 176 nursing students, 73.9% were aged between 17 and 19 years, the majority (76.7%) were females, and 98% of them used mobile phones to access online FL content. Of the novice nursing students, 69.88% agreed, 27.84% strongly agreed, and 2.27% were in a neutral state for readiness to adopt FL in their nursing curriculum with a mean (standard deviation, SD) value of 77.02 (6.27). Among the four domains of readiness, a positive correlation was found between personal with technological readiness (P = 0.001; r = 0.446) and pedagogical with personal readiness (P = 0.003; r = 0.223). Statistically, a significant association was found between students' readiness toward FL with the occupation of the head of the family, gadgets used to access the FL materials, and Wi-Fi/internet availability in the institutions with a P-value <0.05. Conclusions The study showed highly positive readiness for FL among nursing students in nursing subjects. It can be leveraged with educational institutions' environmental and technological support by properly utilizing mobile devices, computer laboratories, and access to the internet/Wi-Fi for students from their entry level to enhance FL.

Nurses' strategies for overcoming barriers to fundamental nursing care in patients with COVID-19 caused by infection with the SARS-COV-2 virus: Results from the 'COVID-NURSE' survey

AIMS

To identify strategies used by registered nurses and non-registered nursing care staff in overcoming barriers when providing fundamental nursing care for non-invasively ventilated inpatients with COVID-19.

DESIGN

Online survey with open-ended questions to collect qualitative data.

METHODS

In August 2020, we asked UK-based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non-invasively ventilated patients with COVID-19. We analysed data using Framework Analysis.

RESULTS

A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non-verbal communication with patients, using information technology to enable patients' significant others to communicate with staff and patients, and establishing clear information-sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self-care and using 'runners' and interdisciplinary input. 3) Addressing patients' well-being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients' wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks.

CONCLUSIONS

Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well-being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing.

IMPACT

As these strategies are unlikely to be exclusive to the COVID-19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.