Table 9 Integration of quantitative and qualitative data on top five barriers to psychosocial care

Wearing PPE (44%)

Emotional wellbeing, anxiety and depression (48%)

Wearing PPE limited verbal and non-verbal communication, rapport building, and physical contact with patients, which impacted on patients’ wellbeing and staffs’ abilities to develop therapeutic relationships and meet patients’ emotional needs. Seeing staff in PPE and being unable to recognise them caused discomfort.

“Wearing full PPE impaired the creation of a therapeutic relationship with the patient. Both patient and staff become de-personalised.” (ID443)

“It must have been terrifying for the patients who did wake up seeing us in our full PPE.” (ID80)

Lack of time (37%)

Emotional wellbeing, anxiety and depression (40%)

In the context of visitor restrictions, respondents experienced more pressure to provide emotional care to patients, but less time to do so as wards were so busy. Staff had little time to sit with patients, provide support, understand their values and beliefs, and attend to their emotional and spiritual needs. They were also reluctant to spend much time in patient rooms or advised not to.

“In critical care we are used to providing the emotional and psychological support needed, but … Covid critical care being busier than usual caused a lot of constraints to do this.” (ID229)

“Lack of time would be the main factor as staff couldn’t fully engage with the patient to understand their beliefs and wishes.” (ID85)

Severity of the patient’s condition (37%)

Dignity and respect (39%)

As many patients were sedated, ventilated and/or short of breath, staff had little opportunity to communicate with them, develop a rapport, assess their emotional/spiritual needs, or find out their wishes and beliefs. Patients and respondents were at times aware when they were likely to die which was overwhelming for all involved.

“The patients were unable to voice their needs.” (ID268)

“Patients’ anxieties were difficult to assess at times.” (ID627)

“Difficult to establish a rapport with patients as they were so short of breath/wearing CPAP masks, therefore difficult to know what their values/ beliefs are.” (ID585)

Lack of knowledge about COVID-19 (25%)

Emotional wellbeing, anxiety and depression (30%)

Due to their lack of knowledge of COVID-19, respondents found it difficult to answer patients’ questions and reassure them about their care and likely outcomes. Patients ‘feared the unknown’ and had anxiety around the lack of COVID-19 knowledge. Given a lack of knowledge of how COVID-19 may impact on patients psychologically, respondents were reacting to this on an ad hoc basis.

“Because it was so new for us too, sometimes it was difficult to answer their questions.” (ID13)

“Lack of knowledge of the disease meant that we were unable to reassure patients about their care and how they were improving.” (ID161)

“Patients were very anxious about Covid-19 as so much [is] still unknown.” (ID204)

Lack of personnel, skill mix, catering, housekeeping or dietetic support (24%)

Dignity and respect (27%)

Due to the COVID-19 risk and some PPE scarcity, some respondents reported that psychology reviews were delayed or not undertaken, and chaplaincy/ religious persons were unavailable, even in end of life scenarios. General staff also had a lack of experience and expertise for identifying and supporting patients with psychological problems.

“As no one could come onto the wards we were unable to get a priest or Imam to come and give religious support.” (ID37)

“Lack of experience and expertise in general staff for identifying psychological problems and helping patients deal with emotional consequences of illness.” (ID4)