Table 7 Integration of quantitative and qualitative data on top five barriers to physical care

Severity of the patient’s condition (41%)

Rest and sleep (50%)

Patients were often fatigued, weak, breathless, bedbound, proned, and had high oxygen requirements. These factors caused discomfort, limited patients’ ability to voice their needs, impeded mobility, interfered with eating/drinking, and restricted staffs’ ability to provide personal care (e.g. bathing; mouth care). The need for frequent monitoring also interrupted patients’ rest.

“CPAP hood made eating and drinking opportunities limited … Their rest and sleep was broken to perform essential care.” (ID988)

“The priorities had to change due to maintaining organ functions that were in critical states and personal care had to be pushed down the priority list.” (ID92)

Difficulties taking items/ equipment in and out of isolation rooms (38%)

Eating and drinking (54%)

Staff spent extra time cleaning items which had entered patients’ rooms, and struggled to prepare all items ready to take in to avoid donning and doffing PPE. Specific difficulties included providing meals/drinks and equipment to support mobility, removing plates/trays and waste products, and not being able to take drug charts into rooms.

“There was a big time lag of having to don and doff in and out of rooms if you forgot a flush, or needed another syringe.” (ID20)

“The rooms for isolated patients were very small and taking equipment in and out and cleaning equipment … was very time consuming.” (ID456)

Wearing PPE (33%)

Hygiene, personal cleansing and toileting (44%)

Respondents struggled to meet patients’ physical needs, especially personal care and moving/turning patients, whilst wearing PPE which was hot, difficult to see through, and created a physical barrier. Changing PPE between patients took time away from meeting their needs, and donning PPE delayed responding to patients’ requests.

“PPE gear has made delivery of any nursing care so much harder, just by the uncomfortable wearing of the masks, vision obscured by visas or goggles and the heat.” (ID590)

“Requirement to wear PPE competes with need to provide assistance promptly.” (ID286)

Lack of personnel, skill mix, catering, housekeeping or dietetic support (30%)

Patient safety (38%)

Respondents noted a lack of physiotherapists, dieticians, pharmacists and domestic staff, which delayed patient care. Nursing staff shortages were stressed, which meant insufficient staff for tasks such as mobilising patients and performing personal care. Redeployed staff could also lack knowledge of equipment, medications and the importance of fundamental care.

“Pharmacists did not visit the ward and they are normally there to support and order drugs so it was another thing that we had to do” (ID83)

“We had plenty of redeployed staff but not always staff that were able to be hands on as they had not been clinical for many many years.” (ID179)

Not enough physical resources such as equipment (24%)

Patient comfort (28%)

Respondents reported shortages of items including feed pumps, chairs, hoists, food, hot drinks, bottled water, weighing equipment, curtains, commodes, soap, wipes, medications and PPE. This was related to a lack of storage in COVID-19 areas, inability to share items with other areas, and need to clean items between uses. This impeded patient mobilisation and the timely completion of tasks.

“Chronic shortage of pretty much everything.” (ID80)

“Simple things like a tray to take food in to isolation rooms in short supply” (ID98)

“Lack of specialist equipment on COVID wards (due to storage or lack of enough equipment to spread between cohort/non-cohort ward)” (ID4)