perception and barriers of intensive care init nurses in comprehensive care during covid 19 pandemic in hanoi medical university hospital vietnam

MINISTRY OF HEALTH MINISTRY OF EDUCATION AND TRAINING HANOI MEDICAL UNIVERSITY PHANI THI DUNG PERCEPTION AND BARRIERS OF INTENSIVE CARE UNIT NURSES IN COMPREIlENSIVE Care during COVTD-19 PANDEMIC IN HANOI MEDICAL UNIVERSITY HOSPITAL VIETNAM GRADUATION THESIS BACHELOR OF SCIENCE IN NURSING Advanced Program in Nursing 2016-2021 Supervisor Assoc Plot Hoang Bui Hai M.D, Ph D Mai Thi Hue MPH Hanoi 2021 TW jfcfc «s ■> iii AC K NOWLEDG EM E NT I would like to express my deepest gratitude to my supervisor Assoc Prof Hoang Bui Hal M.D Ph.D and Mrs Mai Thi Hue MPH for the excellent guidance, caring, patience and providing with tlie tremendous support during this research I am also grateful to all lecturers m the Institute of Intensive care and Emergency department, Hanoi Medical University for their comments, helps and supports I would like to express my sincere thanks to all hospital staff in Intensive CaieUnit at Hanoi Medical University Hospital for their facilitation in data collection process I place on my record, my sincere gratitude to all members in the research team for sharing expertise, valuable support and encouragement extended to me Hanoi May 5’b 2021 Thesis author Pham T1Ũ Dung iv DECLARATION I hereby declarethat this thesis is composed by myself, which has not been previously submitted, either in a pan or in full, for a degree to any other institution or university As far as know, material has been previously published or written by other persons are not contained in my thesis except where reference has been shown in the text Hanoi May 5* 2021 Thesis author Pham Thi Dung -w •* CN «G V CONTENTS ACKNOWLEDGEMENT ill DECLARATION iv CONTENTS ••••• ••• •••••••• LIST OF TABLES ••••• •• •• •• • •’ •••••••••••a \ vm T» ix IN kODCTON ãããããã ô ãã • •M CHAPTER 1: LITERATURE REVIEW 1.1 Comprehensive care model 1.11 Comprehensive care definition ••• •••• 3 1.12 Comprehensive care and the COVID-19 pandemic 1.12.1 Overview of the COVID-19 pundemi c 1.12.2 The situation of comprehensive care before the c OVID-19 pandemic - 1.12.3 The situation of comprehensive care during the COVID-19 pandemic 1.2 The nursing role in comprehensive care 1.3 The barriers of nurses in comprehensive cares - 10 1.4 Comprehensive care in ICƯ, Vietnam 11 CHAPTER 2: SUBJECTS AND METHOD - 13 2.1 study time & setting 13 2.2 Study participants 13 2.3 Studydesign- - 13 2.4 Study instruments 14 vi 2.5 study parameters — 15 2.6 Data collection 16 2.7 Data analysis 18 2.8 The trustworthiness of a qualitative research 20 2.8.1 Credibility of this study _ 20 2.82 Dependability of Ulis study •• !• 2.83 Transferability of this study 2.9 21 Ethical consideration 22 3.1 General cliaracteristics of participants 22 3.2 The barriers of nurses performing Comprehensive care in Intensive care unit during the COVID-19 pandemic 25 3.2.1 Banners related to insufficiency of human resource 26 3.22 Barner related to ovet whelmed and stressed by the nursing workload — 29 3.23 Barrier rdated to the unprofessional structure of the ICƯ35 3.2.4 Barrier related to non-cooperation of tile patient’s relatives 37 3.23 Barner related to the uncertainty and anxiety of being infected COVID-19 and infecting others - 38 3.3 The perception of nurses about comprehensive care in the ICƯ during COVID-19 pandemic • ••••••••••••••••••••••••••••••••••••••••••••••••••• 41 3.3.1 The participant's perspective about the future nursing care model ’ •• • •- •••••• •• •••••••••••••••••••••• ••••••«••••••«• •••••« «• • •• «• • •• •••«•••» 41 3.32 The expected factors that should be available to achieve comprehensive care in the future 42 CHAP I ER 4: DISCUSSION 46 4.1 General characteristic of stud}’ 46 4.2 The barriers of nurses performing comprehensive care in the ICU during the COVID-19 pandemic 48 4.2.1 Ranier related IO insufficiency of human resource 49 4.22 Barrier related to overwhelmed and stressed by the nursing workload 50 4.23 Barrier related to the unprofessional structure ofthe ICU51 4.2.4 Barrier related to non-cooperation of the patient's relatives 52 4.23 Barrier related to the uncertainty and anxiety of being infected with COVID-19 and infecting others 53 4.3 The perception of nurses about comprehensive care in the ICƯ during the COVID-19 pandemic 54 4.3.1 The participant's perspective about the future nursing care model .H 34 4.32 The expected factors that should be available to achieve comprehensive care in the future 55 4.4 Limitation Of this study 56 The research proposal CONCLUSION RECOMMENDATION 59 REFERENCES APPENDIX viii LIST OF TABLES Table The stud}- parameters - 15 Table Participants' demographic information 22 Table 3.2 Characteristics of the study participant 24 Table 3 Main themes reflecting the barriers of nurses performing Conxpt ehens ive care in ICC’ during COVID-19 pandemic.- 26 Table 3.4 Barrier related to insufficiency • of human resource — 27 Table Barner related to overwhelmed and exhausted by the nursing workload — 30 Table 3.6 Barrier related to the unprofessional structure ofthe ICC 35 Table " Barner related to non-cooperation of the patient’s relatives 37 Table Barrier related to the uncertainty and anxiety of being infected COVID-19 and infecting others — 39 Table 3.9 The participant's perspective about the future nursing care modcl41 Table 10 The expected factors that should be available to achieve comprehensive care in tile future 43 Table 11 Human resources factor that should be available to achieve comprehensive care in the fixture 43 Table 12 Medical materials factor that should be available to achieve comprehensive care in the future 44 ix LIST OF FIGI RES Figure The process of Qualitative data collection - 17 Figure 2.2 The Qualitative research process - 19 -w ã* CN ôG X LIST OE ABBREVIATIONS COVID-19 Coronavirus disease 2019 HCWs Healthcare workers ICƯ Intensive care unit HXflJH Hanoi Medical University Hospital WHO World Health Organization -w •* CN «G INTRODUCTION Comprehensive pattern care is a highly nursing healthcare model which has been widely developed in many parts of the world to meet the increasing demand of patients Its principles are based on the combination of both the clinical treatment and non-treatmenT aspects which include personal hygiene, daily diets and mental care [ ] While this model of care has been fundamentally well-established in high-income countries such as the United States, the United Kingdom Australia, and the Netherlands [2J [3 J [4] [5] it is quite a vague concept ill many resources' constraint countries Particular^ in Vietnam, the implementation of comprehensive care has only been constricted to highly standardized, private hospitals: and most public hospitals have been absent or incomplete of this healthcare model In fact, several nursing cares associated to non- treatment aspects have been realized by patient's relatives ỉn 2013 and 20 Id Nutan Potdai el al performed studies in the Intensive care unit (ICV) of Krishna hospital India regarding multiple barriers experienced by nurses and doctors when providing comprehensive care for patients They revealed that increased workload, less equipment and lack of human resources were major baniers for medical staffs [6] [7] The complex progression of the coronanius disease 2019 (COVID-19) pandemic has catastrophically been a global health care burden In addition, nursing care lias consequently changed to adapt to tins new situation To accommodate the Vietnamese nurses in the 1CU have fluff ly practiced “comprehensive care" that consisted of unacccpting the assistance of the patient's relatives as a dedicated model for COVID-19 care 52 cause due to specific and objective factors in the ICU at HMUH regarding the organizational structure of the hospital which is difficult to reconstruct However the design of a larger space in the future needs to be considered by managers On the other hand, the working attitude of security guards has been in relation to the barrier of nurses m providing comprehensive care It directly affects the cooperation of rhe patients relative Accordingly, it affects the collaboration of nurse- patient's relatives That is an objective factor tliat belongs to the organizational structure of tile hospital that has an adverse effect on accomplishing comprehensive care for patients We can improve this circumstance by creating several short courses on communication skills for them and highly consider in the hire entry 4.24 Barrier related to non-cooperation of the patient's relatives Another novel promising finding in the cun ait study was that the influence of patients' relatives on non-cooperation is obviously associated with the barriers to comprehensive care in ICU When the need to visit patients of their relative was not met some of their relatives could become anxious and impatient Thar was a reason why when a small act of displeasure happens to them they get agitated and react violently The negative responses of the patient's family can be harmful to the mental and physical health of medical staff; Moreover, it also affects the progress of medical staffs work completion and the quality of care for patients because it IS tirne-consuming for nurses to explain and deal with family members Additionally, if the nurses upcoming action is underestimated, it could be elevated the hairier related to the non-collation of patient's relative Consequently, it is essential for nurses to accomplish deeply explain to the patiexu's relative and give them some priority in a safety zone 53 4.25 Ban ter related to the uncertainty and anxiety of being infected with COVID-19 and Infecting others From the results, it is clear that one of the barriers the ICƯ nurse facing is tire uncertainty and anxiety of being infected with COXTD-19 and infecting others In the face of this complex disease and multiple unpredictable risks, nurses feared infection and tvoiTied about their families, but the}’ still accomplished to join the fight, took up their responsibilities, concentrated on tlreir duties, and showed a spirit of unity and professional dedication Otherwise, although the participants have experiences with intensive care with a high risk of infection, facing the COVID-19 pandemic they cannot unconcern with One of the indicators that made them get unstable mental is that their lack of clinical experiences with a novel threatening vims while perfoining a new comprehensive care model Tliese basic findings are consistent with research showing by Guan and his colleagues in 2020 [32] regarding the baniers perceived by medical staff coping with the COVID-19 pandemic in China Medical staff experienced fear of infection because of the contagious nature of this vims, close contact with ill patients, and spreading the infection happening to their colleagues Thus, to help them reduce uncertainty and fear, it is necessary to improve their knowledge about infection prevention and control, and persona] safeguard skills In addition, the hospital should provide a safe working environment as much as possible for them M 4.3 The perception of nurses about comprehensive care In the ICƯ during the COVID-19 pandemic 4.3.1 'I hr participant's perspective about the future nursing care model This is an importart finding in understanding the perspective of the ICU nursing care model in the future All participants advocated that comprehensive care is the best choice to implement in lev nursing care Nurses emphasized when rejecting some barriers related to human resources workload etc as indicated in section 3.2 above the nursing care model they willing to accomplish IS comprehensive care Because they realized the effectiveness of tins nrodel can improve the quality of patient care and carh the worldwide orientation When comparing this result to those of previous studies, it must be pointed OUT that there were inconsistent results in the effectiveness of comprehensive care in multiple countries In 2012 de Bruin and colleagues conducted a systematic literature review 10 gain insight into tire features and effectiveness of these new comprehensive care progranc for multi morbidity patients via 28 programs [1] In terms of their effects, it had mixed results and the quality of many studies lagged This leads rhe authors to conclude that it is too early to come to certain conclusions about the effectiveness of comprehensive care aril that more rigorous evaluation studies are needed to determine what is the best care for the population Besides, evidence is also found for the positive effects of comprehensive care on patient health, perceived quality* of care, and satisfaction of patients and caregivers Although in our study, evidence regard 10 the satisfaction of patients aid cat egivers is insufficient 55 4.32 The expected factors that should he available to achieve comprehensive care in the future The promising finding was that there are two main expected factors that should be available to achieve compreliensive care in the future The ICL’ nurse in H.ML1I highlighted those factors associated to the human resources of nursing and medical materials As the result, it has the correlation between the shortage of nurse staff and tamers of nursing in comprehensive care In addition, this finding is consistent with previous research as we discussed Therefore, to meet the participant's need about the nurse personnel, the nurse / patient ratio IS guaranteed, and their work status will not be overwhelmed It has a positive impact on the performance of nursing and improving the quality of comprehensive care for the patient Although tills issue cannot be solved immediately and depends on the organization and coordination of tile hospital management voicing this banier helps to promote their vision in order to strengthen nursing human resources Besides, the fulfilment of medical material also helps rhe implementation of comprehensive care smoothly and restricts those barriers In particular, designing a convenient all-in-one package association facility of medical procedures is a great option that can help participants limited the time-consuming Furthermore, another novel nurses* suggestion about the update and upgrade computer data on character declaration according to the respective sets of care comem that needs to concern On the other hand, creating a template that lists the content of each patient s day-care needs was ail opinion that ICƯ nurses emphasized Só It contributes to reducing rhe workload burden and save energy for nurses Thereby, they can have more time to accomplish fully nursing care for patients 4.4 Limitation of this study A limitation of this study was that all participants had telephone interviews via Zoom meetings because in this study lime was in lockdown and the shift oiganization liad not allowed US to build up a direct group interview Besides, it was more difficult to create rappon with participants over die phone, and non-verbal signs could not be obtained Furthermore, the semi-structured interview guide was not piloted, bur the researcher participating in the interview as a coordinator was trained in interview skills before this study The sample size of this study was uneven with twelve ICƯ nurses at HMUH However, these findings did not ami to compare experiences between nurses and other medical staff Otherwise the COVTD-19 was declared with a rapid outbreak all over the world, a large proportion of infected patients need admission and comprehensive management However, the knowledge about the effectiveness of comprehensive care as well as the barriers of this model to nurses is generally limited, especially in the ICU and that occurs not only in Vietnam but also worldwide Therefore, it has restrictions on the literature review to improve the reliability of the study 57 4.5 The research proposal After understanding the existing problems of implementing comprehensive care, it is crucial for researches to come up with optimal solutions to positively improve research outcomes In this study, it is necessary to clarify and emphasize the addition of nursing staff and reorganization of the structure as well as renew implementation procedures of the current nursing care, specifically, the number of nursing staff that needs to be accommodated is such that tire ideal nurse-to-patient tatio is 1:2 or gređer As a result, each nurse’s workload will be declined, allowing them to increase their focus on meticulous patient care, reduce stress and increase the quality of holistic care In addition, in terms of hospital organization ensure that the securin’ team has good communication quality and has a professional working attitude: be cautious when communicating with the patient's family and design the visit time frame for them while ensuring the safety factor to prevent the CO\ĨD-19 pandemic; Besides, strengthening the trust and enhancing the quality of epidemic prevention of mines to help them work peacefillly away from anxiety and fear Furthermore the convenience of using available kits saves time for the patient 58 CONCLUSION The barriers of nurses performing comprehensive care in the ICT’ during the COVID-19 pandemic (5| Overwhelmed and exhausted by the nursing workload •> The unprofessional structure of the ICƯ •> Non-cooperation of the patienrs relatives 19 and infecting others Ihe perception of nurses about comprehensive care in the ICU the during COVID-19 pandemic ❖ The 1CU nurses perspective about the future nursing care model is Comprehensive care