Whilst the NHS has expanded intensive care capacity during the coronavirus pandemic, we know that caring for critically unwell patients is a highly-skilled, demanding area and great strain is being placed upon nurses and other health workers with critical care skills and knowledge.
Principles of operation
Additional healthcare workers including those from other clinical settings, ODPs, students and returnees, may be asked to provide support in critical care areas.
Whilst their support will be welcome, many won’t be accustomed to working in critical care areas with consequences for the level of supervision they need and professional implications for the registrants working with them.
This has been recognised by national regulators, professional bodies and UNISON. We have agreed principles for the operation of critical care during this emergency response.
Critical care capacity should be expanded in a planned, staged way and there will be a necessary focus on team-working rather than normal, established ratios.
The Chief Nursing Officers of each nation have committed to helping critical care staff through this emergency by:
- providing support and training,
- helping leaders,
- ensuring that those nurses working in unfamiliar environments are adequately supervised and that care is appropriately delegated to them under a specialist framework.
Life support and ethical decision-making
COVID-19 is likely to lead to many situations where challenging decisions about life support and end of life care have to be made.
The UK resuscitation council has published specific guidance on performing CPR and life support in patients with suspected or confirmed infection with COVID-19.
When providing life support in hospital settings, as in other emergency situations, it is always important to ensure your safety and that of your colleagues.
The UK Resuscitation Council says (in regards to life support in hospitals) – ‘AGP PPE provides the safest level of protection when providing chest compressions, CPR and advanced airway procedures in suspected or known COVID-19 cases’
They recommend that NHS Trusts and organisations opt for this level of PPE for the provision of life support and CPR.
Looking after your mental health
The circumstances during this emergency response are likely to lead to significant emotional and psychological distress for all healthcare workers at this time. It’s important you look after yourself and ask for help and support if you need it.
The NHS has set up a free phoneline for staff if they need help:
All NHS staff can call 0300 131 7000 or text FRONTLINE to 85258 to get help, support and advice from thousands of specially trained volunteers, for the pressures they face every day during the global health emergency. The volunteers will listen to NHS staff and give psychological support to those in need.
End of life decision-making
During the response to this pandemic, there is also a pressing need for difficult decisions to be made about care and treatment at the end of people’s lives. These are likely to be even more difficult as a consequence of the strain being placed upon critical care areas in the NHS.
As much as possible these decisions should be made on an individual basis with a holistic assessment of the person, taking account of their wishes and the views of the wider multi-disciplinary team.
Again, contributing to these decisions may be difficult and cause distress and anxiety for healthcare workers. Please support each-other and seek help when needed.
There has been some controversy around the employment of DNACPR decisions for elderly people and people with learning disabilities.
Whilst in many cases decisions not to perform CPR may be appropriate, they should only ever be made after discussions with individuals and their families, taking account of their personal circumstances and not just their medical conditions.
DNACPR decisions also only apply to cardio-pulmonary resuscitation and do not limit other aspects of medical treatment. It will be helpful for individuals with advanced wishes around escalation of care and treatment preferences to document these and to be supported in their decision making by nurses and health workers.