Table 3 Side-by-side comparison of quantitative and qualitative data on missed physical care

Mobility (56%)

Patients in side rooms^a were unable to mobilise by moving freely on the ward and walking to the toilet. Patients were also unable to access facilities such as the gym or garden, or complete stair assessments. Pressure area care and rehabilitation could be missed, and respondents experienced a lack of physiotherapy presence/ support.

“Due to needing to isolate … one of our patients was in his room for 4 weeks.” (ID581)

“Physios would leave C19+ patients to be seen at the end of the day, resulting in a shortened session or missed session.” (ID244)

Rest and sleep (34%)

Patients often experienced sleep which was interrupted by consistent monitoring/ observations and interventions, and by noise and lights. Patients also experienced a lack of time for sleep, difficulties settling, and poor quality sleep.

“There was not much “down time” during the night.” (ID585)

“It was so busy that we couldn’t even switch off the lights … sleep deprivation was present on every night shift.” (ID355)

Patient safety (34%)

Respondents highlighted a reduction in monitoring/ observing patients who were in closed bays or side rooms, and a related increased risk of falls. Respondents also noted various errors and potential for errors, such as medication errors and failures to escalate, and that regular skin checks could be missed.

“Need to isolate patients into side rooms was treated (rightly or wrongly) as more important than their risk of falls.” (ID286)

“Medication rounds not done next to patient. Nursing staff not present in the bays so often.” (ID512)

Eating and drinking (33%)

Respondents noted issues with food/drink supplies such as running out of drinks, lack of choice for patients, and difficulties for patients eating using plastic plates/cutlery. There were some delays in providing food and drink to patients, and between meals these needs could be missed. Some patients were weighed less regularly and some respondents experienced less presence from dieticians.

“Poor nutritional intake for those most vulnerable. Missed regular cups of tea … Gut-wrenching as a nurse.” (ID20)

“Tea trolleys and meal choices were much harder to facilitate. It took longer for diet and fluid to get to patients.” (ID262

Patient comfort (32%)

Symptom control was challenging, particularly breathlessness and temperature, and oxygen equipment was uncomfortable. Patients missed having visitors, and interaction/ time with nurses, which affected their comfort levels. Respondents also noted that nursing patients in the prone position (‘proning’) and difficulties turning patients meant pressure area care could suffer.

“Patients were uncomfortable due to nature of condition, positioning (extended time prone giving them sore joints or back).” (ID475)

“Unable to comfort emotionally distressed patients due to PPE. Lack of family support.” (ID464)

Hygiene, personal cleansing and toileting (27%)

Patients’ personal care could be missed or delayed, particularly mouth care, but also washes, hair brushing and toileting. Less time was spent on personal hygiene, with some patients expected to meet these needs themselves yet not encouraged to do so. Patients’ rooms were also cleaned less often, and patients often couldn’t access private bathrooms.

“Delayed response to washes, often flowing into afternoon.

Personal care, oral care, often missed completely.” (ID20)

“Less assistance. Patient left or expected to meet most hygiene needs themselves and not pushed or encouraged to do this.” (ID130)

Medication management (26%)

Some staff were unable to double check medications and some reported an increase in medication errors. There could be delays in receiving and administering medications, and some respondents ran out of medications. Respondents also experienced a lack of pharmacist presence/support.

“I made my first medication error during the pandemic... Thankfully no one was hurt, but it still haunts me.” (ID529)

“Medications were not available … Pharmacists refused to come to the wards.” (ID703)