The Impact on Staff of Providing Non-Invasive Advanced Respiratory Support During the Covid-19 Pandemic– A Qualitative Study in an Acute Hospital

Objectives

To explore the experiences of healthcare workers of providing Non-Invasive Advanced Respiratory Support (NARS) to critically unwell patients with covid-19.

Design

A qualitative study drawing on a social constructionist perspective using thematic analysis of semi-structured interviews.

Setting

A single acute UK NHS Trust across two hospital sites.

Participants

Multidisciplinary team members in acute, respiratory and palliative medicine.

Results

21 nurses, doctors (juniors and consultants) and physiotherapists described the provision of NARS to critically unwell covid-19 patients as extremely challenging. The main themes were of feeling ill prepared and unsupported, a need to balance complex moral actions, a sense of duty to patients and their families. The impact on staff was profound and findings are discussed via a lens of moral injury. Injurious events included staff feeling they had acted in a way that caused harm, failed to prevent harm or had been let down by seniors or the Trust. Participants identified factors that mitigated adverse impact.

Conclusions

Although many of the issues described by participants are likely immutable components of healthcare in a pandemic there were several important protective factors that emerged from the data. Experience, debriefing and breaks from covid-19 wards were valuable to participants and successfully achieving a peaceful death for the patient was often viewed as compensation for a difficult journey. These protective factors may provide modelling for future education and support services to help prevent moral injury – or aide in its recovery.

Registration

registered on the Open Science Framework <underline>10.17605/OSF.IO/XB8YH</underline>

Strengths and Limitations

• Single Centre Study

• The lead author had pre-existing relationships with study participants

• The lead author, under strict supervision, practiced a reflexivity based approach to data collection and analysis with objectivity benchmarking from the second author.