Table 8 Integration of quantitative and qualitative data on top five barriers to relational care

Wearing PPE (61%)

Non-verbal communication (77%)

Wearing PPE impeded respondents’ abilities to communicate with patients and build a rapport with them. It was difficult to hear and be heard and understood through PPE; not possible for patients to lip read; and not possible for staff to communicate using non-verbal cues, facial expressions/ smiles, physical gestures or physical touch. PPE also hid staffs’ names, made them harder to recognise, and caused fear for some patients.

“The reduction in the human aspect of nursing, being wrapped in plastic and shouting at people who can’t read your face or mouth was horrible.” (ID20)

“It was so difficult to comfort without touch. It was quite alien really.” (ID479)

“We would be very scary to patients in the beginning, as they were not used to staff being in full gowns with masks.” (ID39)

Lack of time (31%)

Communicating with relatives, carers and significant others (41%)

Due to staff being off sick, many patients being very unwell, and increased workloads, respondents were often too busy to sit with, talk and listen to patients, and prioritised a functional approach to care. Clustering care, and minimising time spent in patients’ rooms, also meant that staff spent less time with patients. Respondents also lacked time to contact and update patients’ significant others.

“Due to the pressures of the pandemic on staffing and resources sometimes it was hard to spend as much time talking to the patients as would be desired.” (ID618)

“Not being able … 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)

Severity of the patient’s condition (29%)

Shared decision-making (47%)

Patients were often sedated, using oxygen equipment or experiencing delirium, which made it difficult for them to communicate, understand their care, be involved in decision-making, and contact significant others. Visitor restrictions due to the nature of COVID-19 meant that staff could not get to know patients through their significant others.

“Patients were sedated so unable to make relationships with them. When they were awake a lot experienced delirium.” (ID851)

“There were many times when patients were not well enough and deteriorating so rapidly that we did not really have the time to explain every available option.” (ID377)

Fear of catching COVID-19 (19%)

Establishing a relationship with patients (25%)

Respondents were reluctant to get physically close to patients, and to enter or spend time in their rooms, for fear of contracting COVID-19. They were often advised to minimise time in the patient’s room. Some respondents noted that the quality of PPE did not seem adequate, which led to further fear of contracting COVID-19.

“Peoples’ fear of catching covid meant they rushed time with the patient and didn’t engage with them as much.” (ID558)

“Inadequate PPE meant I didn’t want to stay in room for longer than necessary therefore I didn’t spend extra time getting to know the patient.” (ID160)

Lack of knowledge about COVID-19 (16%)

Shared decision-making (28%)

Respondents could lack sufficient knowledge of COVID-19 to provide patients with reassurance and answers about their condition, treatment and likely outcomes as much as they usually would. This impeded building a rapport with patients and shared decision-making.

“[It was] challenging to reassure them and build a rapport with them, particularly when we couldn’t give them much information on the condition or its management (due to general limited knowledge).” (ID465)