Absent visitors: the wider implications of COVID-19 on cardiothoracic ICU staff: the VINCI Study

Abstract

Patients are not lone entities; they are part of larger social networks containing their family and others. Before the COVID-19 pandemic, visiting policies varied globally1; many ICUs in the UK adopted a flexible approach to visiting. In March 2020 the rapidly progressing pandemic led the Scottish Government to stop non-essential visiting in hospitals. The impact of this policy on non-COVID-19 patients in cardiothoracic ICU, their relatives, and staff involved in their care is unknown. As one part of a mixed-method study, the experiences of staff caring for non-COVID-19 patients in a cardiothoracic ICU unit were explored.Participants were recruited using purposive sampling. Data were collected using semi-structured interviews, transcribed, and analysed using grounded theory.Twenty members of staff were recruited from a range of patient facing roles and experience. From initial coding a range of categories emerged. These were: isolation; delirium management; end-of-life issues; communication; and role and workload. Participants understood the necessity of the national visiting restrictions; however, they observed that the benefits came with notable negative effects on patients and their families.This study shows an increased burden experienced by participants, not solely in the delivery of clinical care, highlighting the possible exposure of clinical staff not involved in COVID-19 care to potentially morally injurious events at this time. Moral injury is associated with events that lead to internal moral conflict and has potential to develop into other psychological issues.2Further research is needed on identifying and supporting clinical staff with moral injury stemming from caring for ICU patients during COVID-19.This study provides some insight into the experiences of clinical staff in the cardiothoracic ICU during the pandemic and should be considered alongside the experiences of patients and their families.