The COVID-19 pandemic has caused an unprecedented health crisis. Pressure on the National Health System has created unique demand particularly in certain services and care units like the critical care units. Objective To learn about the experience of nurses in caring for people with coronavirus in critical care units.
Method A qualitative phenomenological study that constitutes the second phase of a mixed methodology project. We conducted interviews with 17 nurses caring for patients affected by COVID-19 in critical care units. The interviews were audio-recorded, transcribed, and analysed using thematic discourse analysis.
Results This article shows the findings around the theme “the value of human resources” which is nuanced through sub-themes “it's not the beds, it's the expert staff”, “shouldering the patient's burden”, and suffering because “they have not cared well”.
Discussion Expert nurses have emerged as leading professionals in the care of the critical patient during the COVID-19 pandemic. This leadership is executed from a profile framed in an inclusive philosophy where wisdom, agility and intuition are the key elements underpinning problem identification and solving in a creative way, while adapting to the needs of the patient and healthcare team as they emerge.
Conclusions Expert nurses have played an advanced role in the management of care and human resources by exercising effective leadership in the clinical setting. Care has been hampered due to the crisis, which causes nurses moral distress because they have been unable to meet standards of quality and excellence in care.
The WHO declared a global SARS-CoV-21 pandemic on 11 March 2020.1 In the following weeks and during what was termed the first wave of the pandemic, the infection spread rapidly through Europe; 163,515 people had died in the European Union and the United Kingdom by the end of May. In Spain, according to data from the Ministry of Health, there were 238,564 confirmed cases, and 27,121 deaths.2 The autonomous community of Madrid (CAM) was one of the worst affected regions. The demand for health care put great strain on the public health system, whose material and human resources were insufficient. Public hospitals had to allocate a large part of their facilities to caring for the more than 40,000 infected people who had to be admitted. The spaces for the care of critically ill patients had to be extended and provided with the necessary equipment and staff. Nurses of the intensive care units and of the new spaces specifically created in the autonomous community of Madrid’s public hospitals were responsible for the care of the 3574 people hospitalised in these units over those months.3
Expert ICU nurses have played a leading role in the care teams during the first wave of the pandemic, demonstrating their potential to manage complex clinical situations. They have acted as mentors to novel professionals and shouldered the patient burden in situations of scarce material and human resources (experts), chaos and uncertainty, demonstrating a remarkable capacity for adaptation.
The impossibility of continuing to care in the usual way, having to prioritise war care (minimum care, survival care) over detailed care (individualised care, ‘‘caring’’) and the need to organise this on a task basis (versus patient-centred care) has been accompanied by a profound experience of moral distress, thus making them ‘‘second victims’’ of the pandemic.
The presence and accompaniment of patients and families has taken on special significance for nursing professionals, becoming a way of relieving mutual suffering.