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Table 4 Side-by-side comparison of quantitative and qualitative data on missed relational care

From: Fundamental nursing care in patients with the SARS-CoV-2 virus: results from the ‘COVID-NURSE’ mixed methods survey into nurses’ experiences of missed care and barriers to care

Care category (% rating care as worse)

Summary of qualitative data on missed care

Quotes demonstrating qualitative data

Talking and listening (57%)

Many respondents highlighted a lack of rapport building with patients, and lack of clear communication with patients (i.e. being heard and understood), specifically noting the inability to lip read through PPE. Related to this, respondents stressed reductions in nurse-patient contact, including both physical touch and time spent with patients.

“Wearing PPE especially masks meant that patients often could not hear you and you would have to repeatedly talk to them which made conversation and flow more difficult.” (ID328)

“You can’t hear properly with shields. You can’t see properly. I lip read as well as listen, this is very difficult. Verbal [communication] is difficult with softly spoken patients.” (ID505)

Communicating with relatives, carers and significant others (57%)

Patients missed having visits from significant others and were accordingly isolated. Staff had less opportunity to build relationships with significant others and manage their emotional needs, and noted that significant others were not always updated in a timely and regular manner. Staff experienced difficulties keeping significant others fully informed over the phone whilst ensuring confidentiality was maintained.

“Patients struggled with lack of family contact.” (ID573)

“Regular updates with relatives and carers were not always achieved.” (ID427)

“It has also been difficult building a rapport with families and relatives... This has added difficulty as they are unable to see the environment their loved one is being care in.” (ID579)

Non-verbal communication (54%)

Staff were less able to communicate with patients using facial expressions, non-verbal cues, physical gestures and touch. Some respondents therefore felt that they were showing less comfort, reassurance, empathy and friendliness towards patients. They also had a reduced ability to pick up on patients’ non-verbal cues and respond to their needs accordingly.

“Patients unable to read facial expressions, see non-verbal cues, see the nurse was being empathetic and compassionate to their needs as they were unable to see nurse’s faces.” (ID332)

“Visitors (who normally pick up on missed cues) unable to visit.” (ID204)

Establishing a relationship with patients (49%)

Some respondents highlighted the same issues as experienced in relation to ‘talking and listening’, also noting that it was harder to get to know these patients; that functional care could be prioritised over relationship building; and that they missed opportunities to obtain information about patients from their significant others as usual.

“The human aspect of nursing care. Not being able to smile. To sit and make a cup of tea and listen to the patient’s opinion of how their stay was going. Every aspect of nursing became clinical.” (ID20)

“Difficult to hear and communicate whilst wearing PPE, therefore loss of personal touch.” (ID585)

Shared decision-making (32%)

Some respondents experienced decision-making as more rushed and policy-led (e.g. escalation/ resuscitation plans) with somewhat less involvement from the patient and significant others. Staff were also less equipped than normal with the knowledge required to answer patients’ questions and provide information during decision-making.

“Due to nature of virus decisions were often made in patients’ best interests, without being able to discuss them with patient or family.” (ID204)

“It was decided that all patients over a certain age would be DNAR, it was hard to justify this.” (ID368)

  1. DNAR Do Not Attempt Resuscitation