Critical care work during COVID-19: a qualitative study of staff experiences in the UK

Abstract

Objective: To understand National Health Service (NHS) staff experiences of working in critical care during the first wave of the COVID-19 pandemic in the UK.

Design: Qualitative study using semistructured telephone interviews and rapid analysis, interpreted using Baehr's sociological lens of 'communities of fate'.

Participants: Forty NHS staff working in critical care, including 21 nurses, 10 doctors and advanced critical care practitioners, 4 allied health professionals, 3 operating department practitioners and 2 ward clerks. Participants were interviewed between August and October 2020; we purposefully sought the experiences of trained and experienced critical care staff and those who were redeployed.

Setting: Four hospitals in the UK.

Results: COVID-19 presented staff with a situation of extreme stress, duress and social emergency, leading to a shared set of experiences which we have characterised as a community of fate. This involved not only fear and dread of working in critical care, but also a collective sense of duty and vocation. Caring for patients and families involved changes to usual ways of working, revolving around: reorganisation of space and personnel, personal protective equipment, lack of evidence for treating COVID-19, inability for families to be physically present, and the trauma of witnessing extreme patient acuity and death on a large scale. The stress and isolation of working in critical care during COVID-19 was mitigated by strong teamwork, camaraderie, pride and fulfilment.

Conclusion: COVID-19 has changed working practices in critical care and profoundly affected staff physically, mentally and emotionally. Attention needs to be paid to the social and organisational conditions in which individuals work, addressing both practical resourcing and the interpersonal dynamics of critical care provision.

Keywords: COVID-19; intensive & critical care; organisation of health services; qualitative research.

Figure 1

Key features of communities of fate (adapted from Baehr, 2005).

Figure 2

Data extracts illustrating critical care as a community of fate during COVID-19. ITU, intensive therapy unit; PPE, personal protective equipment.

Figure 3

Data extracts illustrating critical care as a community of fate during COVID-19. ITU, intensive therapy unit; ODP, operating department practitioner; PPE, personal protective equipment.

Figure 4

Data extracts illustrating critical care as a community of fate during COVID-19. ICU, intensive care unit; ITU, intensive therapy unit.

Figure 5

Data extracts illustrating critical care as a community of fate during COVID-19. ACCPs, advanced critical care practitioners; ICU, intensive care unit; NHS, National Health Service; ODP, operating department practitioner; PPE, personal protective equipment.