It takes a family: critical care and Covid-19

FAMILY   /   noun  :  “a group of people from a common stock”

                                  “ a group of one or more … living together as a unit”

TEAM   /  noun  :   “two or more people working together”

Team   / verb  :     “come together as a team to achieve a common goal”

The most striking thing I’ve found in my first three months since joining critical care is the close-knit community who inhabit it.  Being new, and looking at all those around you for guidance and support, you are in the unique position of watching how this team works together.  You observe a multi-faceted balance of emotional fortitude and empathy, combined with quick thinking, a dedication to continuous learning, alongside an observant eye on the most critically ill patients.

The direct balance of strength to get through tough situations, with the emotional intelligence to communicate with patients, families and each other at the most difficult times.

The impact Covid will have, not only on patients, but all healthcare workers, is as yet, unknown.

I, like many of my healthcare colleagues, am often uncomfortable with the warlike rhetoric used when discussing the current situation, we were none of us conscripted to any ‘frontline’.  However, unquestionably, the challenges the pandemic has faced us with are often synonymous with a ‘battle’ and in some instances, the solidifying of teams as healthcare professionals ‘fighting against’ it has strengthened resolve and even emotional capacity.

Given this current climate, where the world is, in many cases, taking notice for the first time, and recognizing the value of its health systems.  I wanted to attempt to shine that spotlight on the amazing team I have been able to join.  And, in doing so, give an accurate depiction of life on critical care during Covid.  And who better to tell you than the team themselves.

The ACCP in the covid pandemic.     Anwen Williams – Advanced Critical Care Practioner 

I have been a qualified nurse for 30 years, worked on critical care for 19 years and as an accp since 2013 and thought that nothing could come along and shock me, what’s the saying? been there, done that, got the tshirt, then along came covid19.

The newspapers,television programmes and social media were rife with how it was sweeping the world, how countries were coping or not and how health care institutions and providers were under immense pressure due to the demands on the service and the unpredictability of the disease process.

Preparation for the unknown was intense, supplies, equipment, staff training and upskilling of staff outside of the critical care unit, we all chipped in, still no real idea what was in store.

It felt like we were waiting for covid for ages, our colleagues in the south were swamped and we were waiting and waiting and then it arrived….

All the drills, all the teaching, all the sim training could not and did not prepare us for the reality.

Two things had a massive impact on me and will always stay with me:

1. On first assessment the patients look well- to the point that the normal ‘end of the bedogramme’ would not trigger your spidey senses. Sat there, chatting, on O2, looking extremely comfortable but tachypneic- then you see the ABG- po2 of 6-7, pf ratio of < 18 in normal circumstances we’d be prepping the drugs and grabbing an ET tube- CPAP initially was not to be used- the patients tired quickly and that ET tube was never far away. Multiorgan failure, respiratory and cardiovascular instability came on so very quickly- being the accp donned in the ventilated covidbay was a scary place to be, always aware that if you needed help it would not come quickly also who was going to be your help a ward doctor with some critical care experience or one of your colleagues and communication and advice given over walkie talkies was difficult-

2. Communicating with relatives over the phone has to be one of the hardest things I have ever done. Knowing that it was unlikely that the relative had a support mechanism at home and you were about to have some of the most distressing conversations they will ever have over the phone, without that relative having any real concept of how unwell their relative really was, there is a lot to be said about seeing a critical care patient with all the machinery and infusions. Updates were given daily and although some patients did improve and recover to the point of discharge from the critical care unit many didn’t. Although the relatives were always grateful for the phone call, for those making the calls the impact psychologically was massive. I will never forget sitting at the bedside of a patient while he died with one of the nurses and then phoning their wife to tell him he’d passed away. You hold it together for their sake, its their loss not yours, but once I put that phone down I sobbed, it went against everything you’ve been taught.

Ollie Smith – CT2 Anaesthetics

“I moved from theatre where I had just started my Anaesthetics training, to ITU, when the Covid pandemic started.  I felt very helpless.  Patients were intubated early, quickly went into multi organ failure, and decisions had to be made about treatment, as we only had a limited number of machines and staff to manage them.

Patient progress was very slow, and I was very worried we would not cope if more and more patients required critical care.  Thankfully, it seemed to ease after 3 very hard months, and we did cope as a team.”

Nursing during Covid – a nurse’s perspective

“My name is Rachel and I’m a critical care nurse in the Wrexham Maelor Hospital.  I will never forget hearing about ‘coronavirus’ back in December / January, and I never thought it would affect us the way it has.  I have a clear memory of being on a night shift, sat in the restroom during my break, and listening to Boris announce the first lockdown.  It all began to feel very real at that point, and things just progressed from then on.  

Initially, I felt quite anxious; worrying about catching the virus and passing it on to my family; worrying about the PPE, but also worrying for the patients, and if they would survive.  As time progressed, I learnt to trust the PPE, and gradually we all got used to working in a different way and in different conditions.

We also learnt so much about the virus itself, and how best to care for our patients, and started to see patients leave the critical care unit and recover.  It has been, without a doubt, a strange year, and I’m hoping things begin to normalisenext year for all of us (and from a personal perspective as I get married next year!!) “.

“My name is Clariza and I am a critical care nurse in Wrexham Maelor hospital.  I had heard a lot of things about Covid and how it spread rapidly in different countries, causing severe respiratory distress.  I had lots of worries and uncertainties of how it would affect us as nurses and affect our families.  

Initially, we were advised if the hospital reached full capacity with Covid, one option may be for us to stay at the hospital, to safeguard our families,  as our service might be needed continuously.  So, we came to each shift with a bag packed with basic toiletries, clothes and snacks in the boot of our car, in case that day came.

When I told this to my family, my daughter was very upset and I remember her clearly, asking “Can you not be a nurse and stay home with us?” and I answered,“we have to help these patients, it’s our line of duty”.

We were taught and trained by one of our consultants, who is highly trained in infectious diseases and had worked in Sierra Leone working with Ebola patients.  He taught us how to don and doff correctly and how to protect each other in the unit.  

In March, Covid-19 patients cases in ITU rose and so did stress and anxiety levels.  The patients coming in were very sick – they were hypoxic, requiring high pressure oxygen, and many ended up on ventilators to maintain their oxygenation.  They were difficult to ventilate and we often proned them, with the help of our physiotherapy colleagues.  Keeping the fluid balances was a challenge too, and many of them ended up needing haemofiltration.  The coagulation was a problem too, and now one of the first line treatments for these patients are high doses of clexane.

It was physically and mentally draining, I have seen many tears among colleagues.  I rely on my colleagues and family for support.  It has been a very difficult time and looking back, I’m glad I’m still here and want to say thank you to my fellow nurses who stand by me every day”. 

Healthcare Support Workers

“Although i have worked as a health care support worker for over 30 years, i joined the critical care team in March, just as Covid hit.  It was very scary at times, i felt mentally drained after some shifts as well as physically exhausted- seeing people ventilated and proned for hours at a time was something I was not used to.  It got quite upsetting at times as some of these patients were so young.

Wearing PPE for most of the 12 hour shifts was hot and tiring and made communication difficult.  I found the first wave of Covid very challenging, both physically and mentally and was worried about taking it home to my family.”

Physiotherapists during Covid

“We had to change our working pattern, as we were involved in the proning team.  We were able to help our nursing colleagues in the nursing care of the patients – repositioning, washing and even last offices.  

We felt part of the big critical care team, it broke down barriers and hierarchy and made us appreciate the value of our nursing colleagues, and vice versa.  

There were some difficult times also – the wearing of the PPE, the sadness of patients passing away, and relatives not being able to visit.

As physiotherapists, we were able to follow patients on their journey to recovery from critical care to the ward, getting them back on their feet ready for discharge.

Domestics

“As one of the relief domestics who works on critical care, we had to change the way we work.  There became many extra tasks, wearing the same full level 2 PPE as our colleagues, and this was, at times very challenging.  Throughout this whole time however, we have felt very safe and felt part of the wonderful critical care team”

Ward Clerks

“My roles as a ward clerk on the critical care unit are to be the first point of contact for relatives, medical teams and all other visitors to the ward and direct people to the where they want to go.  I do all of the administration and paper work for patients and take telephone calls

Whilst working through the Covid-19 pandemic, I felt a mixture of feelings including fear – of contracting the virus and passing it on to family and friends.  I also felt very proud to be a part of an incredible team that are supportive, caring and still keep a sense of humour to cheer us all up.

Some days were very busy and hectic but we still all remained calm and professional.  I think this pandemic has shown us just how well we all work together as a team”

Icnarc Clerk

“It has been very different collecting the Intensive Care audit data during the Covid period.  One of the most challenging things been access to the daily data due to the need for PPE.  The data was also needed to be submitted daily at times, which has me having to ask the already busy nursing staff for the information that I would normally collect myself.  Even though they were obviously very busy, they never complained and the unit always made the deadline for the data”.

It goes without saying there are many more people who make up the critical care family, including pharmacy, dieticians and many others, and it wouldn’t run without the help of every one of them.  

Like families, teams come in all sorts of shapes and sizes. Whilst there are many theories on what makes an effective team, or the best leaders – there is no surefire recipe for success. Whilst it is unquestionably a combination of effective leadership, good communication, access to resources and the ability for all members to collaborate, the essence of a good team seems to be people who understand each other and work well together through thick and thin. Covid may have tested the team but it made the family.

Kayte www.twitter.com/kayte83

Published by RCN Newly Qualified Nurses

The voice of newly qualified nurses within the Royal College of Nursing. Providing support from six months pre-registration throughout preceptorship.

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