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Learning from the experience of nurses to deliver the best care for COVID patients

Published: 15 March 2021

Professor David Richards, NIHR Senior Investigator Emeritus and Professor of Mental Health Services Research at the University of Exeter, is leading research to establish the best way to provide nursing care during a COVID-19-type crisis. 

When Boris Johnson gave his first speech after leaving hospital where he’d been treated for COVID-19, he thanked the nurses profusely. The Prime Minister emotionally name-checked several of the nurses who cared for him during what was surely a stressful and traumatic time. He described the care he’d received from these nurses as “astonishing” and said he’d be grateful for the rest of his life. 

Nurses up and down the country have delivered astonishing care to thousands of patients and responded magnificently to the COVID-19 pandemic. They have risen to these challenges with resilience, and outstanding teamwork.

And yet, when my research team surveyed 1,000 nurses about their experiences delivering care to patients with COVID-19, between 25-67% of them identified areas where care was ‘missed’. 

They also told us about the barriers that caused this. Not surprisingly, top of the list was the impact of personal protective equipment on critical nursing skills like communication and relationship building with patients. Other highly cited issues were the severity of patients’ conditions, difficulties organising equipment in COVID-secure environments and a lack of time, skill-mix and knowledge.

Understanding nurse and patient experiences of COVID care

This survey was part of the COVID-NURSE trial, a study led by myself and funded by NIHR and UK Research and Innovation (UKRI). The study includes a team at 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. The study is a nurse-led randomised controlled trial of a nursing guideline to meet the fundamental care needs of COVID-19 patients in hospital.

During the development of new clinical guidance we consulted with a group of patients who had been in hospital during the first wave with COVID-19. Just like the Prime Minister, they were overwhelmingly positive and grateful for the nursing care they had received. We worked with them to identify areas where things could have been improved, and they made positive suggestions about relatively simple things that could improve care. 

As well as helping to shape the clinical guidance, working with this fantastic group of patients has helped us to ensure that patients’ needs are represented. Importantly, just like the patients we talked to, nurses in the survey also told us how to overcome the barriers they experienced. They described a host of strategies and innovations that we in the COVID-NURSE team integrated into 26 simple ideas for enhancing care. We also synthesised a number of approaches that clinical managers can try when organising care, for educating and supporting their nursing teams.

Developing and testing new guidance

These ideas have now been incorporated into a clinical guideline for pandemic nursing care, the first such guideline globally. This COVID-NURSE guideline has been designed by nurses for nurses. It includes the very best of nursing care, including the innovations and problem-solving ideas characteristic of nursing.

We are now testing this approach in a cluster randomised controlled trial across the NHS, using carefully designed support materials and easy-access online education resources. When they go online, nurses can watch short videos from patients and nurses describing how they have experienced or delivered care. 

Our patient and public involvement colleagues have contributed their own stories to help nurses really connect and empathise with the experience of being in hospital with COVID-19. Together with the practice innovations from nurses, these case studies provide meaningful examples of how small things matter to patients and equally how small changes can make a big difference.

Following the science

Just like biological scientists testing new treatments, nurses want to know if their innovations are translating into real patient benefit. Nurses too are trained to follow the science. 

Supported by the University of Exeter’s Clinical Trials Unit, the COVID-NURSE study is providing the first scientific guidance for nursing during a pandemic, testing nursing procedures and practices with the same scientific rigour we would apply to evaluating a new medicine.

This rigorous exercise will have national and international benefits, creating a nursing protocol and finding out what really works, enabling us to provide our nurses with a system of nursing that they know will deliver the most benefit to patients. 

Professor David Richards, NIHR Senior Investigator Emeritus, Chief Investigator of COVID-NURSE trial and Professor of Mental Health Services Research, University of Exeter

Over the last year, there has been a huge collective effort to develop treatments, care, and vaccines in response to COVID-19. 

In recognition, the NIHR is launching a campaign to say thank you to everyone who has been involved. 

See the NIHRs response to COVID-19.

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