Beyond the mask: a multidisciplinary reflection on palliating patients with COVID-19 receiving continuous positive airway pressure ventilation

Hough, Amy; Dell, Georgia Daisy; Blaber, Michael; Kavanagh, Diana; Lock, Anna

doi:10.12968/ijpn.2020.26.7.336

Cited by 6 publications

(33 citation statements)

References 3 publications

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“…"It appeared in the interviews that 15 out of 16 patients and 4 relatives all expected and wanted to be treated with NIV despite displays of resistance" [13] NARS as an Anchor While there were potential symptom benefits to NARS these were counterbalanced by significant treatment burdens. NARS may represent an anchor which adds burden to the patient and which of these opposing pulls is stronger, the hope and relief of the buoy or the symptom burden of the anchor, is difficult to predict [16,19,22,24].…”

Section: Nars As a Buoymentioning

confidence: 99%

“…Not being able to think straight, made them focus on breathing as a main issue." [13] Patients experiencing a critical respiratory illness are prone to anxiety [15,16,19,22,25] but NARS can further exacerbate this [7,17,19,22]. This may be driven by worsening breathlessness but is also contributed to by feelings of claustrophobia related to the interface [13,16,17,22] and the noise of the machine [15,16,17,22].…”

Section: Nars As a Buoymentioning

confidence: 99%

“…[13] Patients experiencing a critical respiratory illness are prone to anxiety [15,16,19,22,25] but NARS can further exacerbate this [7,17,19,22]. This may be driven by worsening breathlessness but is also contributed to by feelings of claustrophobia related to the interface [13,16,17,22] and the noise of the machine [15,16,17,22]. The noise of NARS and the mask created issues in communication which complicated all aspects of care.…”

Section: Nars As a Buoymentioning

confidence: 99%

“…"At times, it felt dehumanising to have to almost shout at patients to be heard" [16] The mask impacted the ability of healthcare workers to provide basic nursing care, such as mouthcare [12,16].…”

Section: Nars As a Buoymentioning

confidence: 99%

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Symptom Management When Non-Invasive Advanced Respiratory Support is Used During End-of-Life Care: A Systematic Review

Wenzel

Bleazard

Pepper

et al. 2022

Preprint

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Objectives: to narrate the canon of knowledge around symptom control at end of life for patients using, or having recently used, non invasive advanced respiratory support (NARS) at end of life for respiratory failure. Methods: A systematic review forming a narrative synthesis from a wide range of sample papers from Medline, Embase, CINAHL, Emcare, Cochrane and OpenGrey databases. A secondary search of grey literature was also performed with hand searching reference lists and author citations. The review was undertaken using the ENTREQ checklist for quality. Results: In total 15 studies were included in the synthesis and four themes were generated: NARS as a buoy (NARS can represent hope and relief from the symptoms of respiratory failure), NARS as an anchor (NARS brings significant treatment burden), Impact on Staff (uncertainty over the balance of benefit and burden as well as complex patient care drives distress amongst staff providing care) and the Process of Withdrawal (withdrawal of therapy felt to be futile exists as discrete event in patient care but is otherwise poorly defined). Conclusion: NARS represents a complex interplay of hope, symptom control, unnaturally prolonged death and treatment burden. The literature captures the breadth of these issues but further, detailed, research is required in almost every aspect of practice around end-of-life care and NARS, especially how to manage symptoms at the end of life.

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Section: Nars As a Buoymentioning

confidence: 99%

Section: Nars As a Buoymentioning

confidence: 99%

Section: Nars As a Buoymentioning

confidence: 99%

Section: Nars As a Buoymentioning

confidence: 99%

See 2 more Smart Citations

Symptom Management When Non-Invasive Advanced Respiratory Support is Used During End-of-Life Care: A Systematic Review

Wenzel

Bleazard

Pepper

et al. 2022

Preprint

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“…NARS is used extensively in the treatment of covid-19, despite a high mortality rate and significant treatment burden [1]. A considerable number of patients die either still using NARS or after its withdrawal; a procedure which represents a time of great uncertainty for both staff and patients [2]. Despite this, there is little data or guidance for clinicians caring for these patients at the end of life.…”

Section: Introductionmentioning

confidence: 99%

The Impact on Staff of Providing Non-Invasive Advanced Respiratory Support During the Covid-19 Pandemic– A Qualitative Study in an Acute Hospital

Wenzel¹,

Bleazard

Wilson

et al. 2022

Preprint

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Objectives: To explore the experiences of healthcare workers of providing Non-Invasive Advanced Respiratory Support (NARS) to critically unwell patients with covid-19. Design: A qualitative study drawing on a social constructionist perspective using thematic analysis of semi-structured interviews. Setting: A single acute UK NHS Trust across two hospital sites. Participants: Multidisciplinary team members in acute, respiratory and palliative medicine. Results: 21 nurses, doctors (juniors and consultants) and physiotherapists described the provision of NARS to critically unwell covid-19 patients as extremely challenging. The main themes were of feeling ill prepared and unsupported, a need to balance complex moral actions, a sense of duty to patients and their families. The impact on staff was profound and findings are discussed via a lens of moral injury. Injurious events included staff feeling they had acted in a way that caused harm, failed to prevent harm or had been let down by seniors or the Trust. Participants identified factors that mitigated adverse impact. Conclusions: Although many of the issues described by participants are likely immutable components of healthcare in a pandemic there were several important protective factors that emerged from the data. Experience, debriefing and breaks from covid-19 wards were valuable to participants and successfully achieving a peaceful death for the patient was often viewed as compensation for a difficult journey. These protective factors may provide modelling for future education and support services to help prevent moral injury or aide in its recovery.

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Impact on staff of providing non-invasive advanced respiratory support during the COVID-19 pandemic: a qualitative study in an acute hospital

et al. 2022

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ObjectivesTo explore the experiences of healthcare workers providing non-invasive advanced respiratory support (NARS) to critically unwell patients with COVID-19.DesignA qualitative study drawing on a social constructionist perspective using thematic analysis of semistructured interviews.SettingA single acute UK National Health Service Trust across two hospital sites.ParticipantsMultidisciplinary team members in acute, respiratory and palliative medicine.Results21 nurses, doctors (juniors and consultants) and physiotherapists described the provision of NARS to critically unwell COVID-19 patients as extremely challenging. The main themes were of feeling ill prepared and unsupported, a need to balance complex moral actions and a sense of duty to patients and their families. The impact on staff was profound and findings are discussed via a lens of moral injury. Injurious events included staff feeling they had acted in a way that caused harm, failed to prevent harm or had been let down by seniors or the Trust. Participants identified factors that mitigated adverse impact.ConclusionsAlthough many of the issues described by participants are likely immutable components of healthcare in a pandemic, there were several important protective factors that emerged from the data. Experience, debriefing and breaks from COVID-19 wards were valuable to participants and successfully achieving a peaceful death for the patient was often viewed as compensation for a difficult journey. These protective factors may provide modelling for future education and support services to help prevent moral injury or aide in its recovery.Trial registration numberRegistered on the Open Science Framework, DOI 10.17605/OSF.IO/TB5QJ

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Beyond the mask: a multidisciplinary reflection on palliating patients with COVID-19 receiving continuous positive airway pressure ventilation

Cited by 6 publications

References 3 publications

Symptom Management When Non-Invasive Advanced Respiratory Support is Used During End-of-Life Care: A Systematic Review

Symptom Management When Non-Invasive Advanced Respiratory Support is Used During End-of-Life Care: A Systematic Review

The Impact on Staff of Providing Non-Invasive Advanced Respiratory Support During the Covid-19 Pandemic– A Qualitative Study in an Acute Hospital

Impact on staff of providing non-invasive advanced respiratory support during the COVID-19 pandemic: a qualitative study in an acute hospital

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