A University of Exeter-led national research team, including PenARC's Evidence Synthesis and Patient and Public Involvement in Research teams, are researching nursing care for patients in hospital with COVID-19. Funded by the National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI), the team will evaluate a system of nursing care designed specifically for COVID patients in a large clinical trial across the UK.
Nursing is hugely important to people in hospital. Nursing care makes a significant difference to the way people experience being in hospital and to their recovery. For people with COVID-19, their symptoms and the infectiousness of the virus pose unique challenges for nurses in delivering this care.
Across the UK, clinical teams have innovated to meet challenges such as communicating with patients while wearing face masks and other PPE. In one example, nurses have pinned pictures of themselves to uniforms, so patients know who is caring for them.
The team has been awarded £430,000 to set up the ‘COVID-NURSE’ trial, which will evaluate the impact on patient experience of a combination of these specific nursing innovations. Generated by a consortium of universities and NHS trusts, this evidence will help nursing teams nationally and internationally to adopt best practice.
David Richards, Professor of Health Services Research at the University of Exeter and a nurse himself, is leading the study. He 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.”
The team includes patients as well as scientists from the universities of Leicester, Nottingham, Southampton and King’s College London, and NHS Trust, as well as Leeds Teaching Hospitals NHS Trust, the Royal Devon and Exeter NHS Foundation Trust, the Royal Marsden NHS Foundation Trust and the NIHR Applied Research Collaboration (ARC) South West Peninsula. The trial, supported by the UKCRC-registered University of Exeter Clinical Trials Unit, will examine academic literature from previous viral outbreaks and undertake a survey of innovations from NHS clinical teams. They will work with patients, nurses, other health care workers and doctors to design specific nursing procedures for these patients.
They will then undertake a type of randomised controlled trial called a ‘rapid-cycle’ trial, which will allow the team to quickly test these procedures across an initial 18 NHS sites to determine their impact on patient experience, care quality, patients’ ability to manage day-to-day activities, treatment outcomes and costs.
Professor Richards added: “We will ensure our nursing procedures are acceptable and realistic for rapid NHS implementation, providing guidance and education materials. We will ensure they could be adapted for care homes, patients with other conditions requiring isolation and to global health systems.”
At the Royal Devon & Exeter NHS Foundation Trust, staff redesigned areas of the CULM ward to accommodate greater amounts of oxygen being required.
Clinical Nurse Manager Tory Elworthy said: “The team supported one another closely, which brought us closer together. We continued our ethos of compassionate and empathetic care in this challenging time. Even though our nurses were nursing slightly differently, their dedication and compassion never changed.
“Staff communication was paramount to ensure we all felt supported. We provided daily updates and weekly newsletters as well as a support and a wellbeing notice board. The staff worked in teams in our high dependency unit, each taking turns to provide care. We ensured all PPE had been fitted properly and we had a rolling testing system to ensure everyone was up to date.”
Clinical Nurse Manager Clare Bakere said: “It was really challenging in a number of ways, including patients not being able to see their families at a very distressing time. We really welcome the COVID-NURSE trial. We need to know what really works for patients. Having a new and specific protocol for nursing will mean we can all work across the UK to the same high standards.”