ORGANISATIONAL RESPONSE AND THE EXPERIENCE OF THE INTENSIVE CARE UNIT (ICU) MULTIDISCIPLINARY TEAM DURING THE PANDEMIC IN CHILE: AN INTERVIEW STUDY

J. Aguilera-Scarpati^1,2, A. Castro-Avila^3,2

¹Clinica Los Andes, Intensive Care Unit, Santiago, Chile, ²Clínica Alemana Universidad del Desarrollo, Carrera de Kinesiología, Santiago, Chile, ³University of York, Department of Health Sciences, York, United Kingdom

Background: ICUs faced a sudden increase in demand during the pandemic, which put normal clinical and working practices under strain.

Purpose: To explore how the ICU multidisciplinary team experienced their hospital/ward response prior to and during the pandemic.

Methods: We conducted 30-minute semi-structured qualitative telephone or video call interviews with consultants, nurses, physiotherapists and healthcare assistants who worked >72 hours in the ICU during the pandemic in seven private and public hospitals in Chile. The study was advertised through posters in the ICUs and messages in clinical WhatsApp groups. Interested participants provided their personal contact details and consented to participate on a google form. We sampled participants to achieve maximum variation regarding years of experience, profession, and hospital where they worked. A clinical psychologist trained in qualitative methods conducted the interviews and provided emotional support if/when the interview topics were too sensitive. The topic guide focused on three areas: functions within and relationship with the team; organisational preparation; and cognitive, physical and organisational challenges. All interviews were audio recorded. Interviews were transcribed verbatim aided by the software Scrintal. Two independent researchers analysed the data following the principles of the thematic analysis by Braun and Clarke (2006). We presented the initial findings during a focus group with eligible participants that had not been interviewed to explore if our interpretations resonated with their experiences.

Results: Eighty healthcare professionals signed up, of which we interviewed 38 between October 2020 and January 2022. Twenty-three(60%) were females, 15(39%) were physiotherapists, 9(24%) were nurses, 7(18%) were healthcare assistants, and 7(18%) were ICU consultants. Twenty-one(55%) had worked in ICU for three to 10 years. We identified seven themes: 1) Opening and conversion of units into ICUs occurred “as the pandemic was unfolding”; 2) This required a “change of usual roles” where more experienced professionals took on provisional managerial roles to supervise inexperienced staff while keeping their clinical duties, working extended hours in new teams; 3) Many experienced “social isolation, exhaustion, and lack of psychological support” due to infection control policies, increased workload and inappropriate/delayed institutional support; 4) “Fear of becoming a vector for infection” meant they implemented hospital-grade cleaning protocols at home; 5) “Soldier mentality” where professionals thought they had to keep working regardless of the conditions or their own wellbeing; 6) “Depersonalisation” as being detached from their own feelings, but also as losing the human touch with patients; and 7) “Uncertainty” whether the course of treatment was appropriate and up-to-date for each patient, which led to continuous learning via making mistakes.

Conclusions: Our interviewees perceived the institutional preparation as insufficient during the pandemic, which led to a more-than-expected workload increase, exhaustion, and personal sacrifices to maintain standards of care. Institutional measures to support the workforce were perceived as late, inadequate, or insufficient.

Implications: In an emergency situation, hospital managers need to communicate better with staff to gauge how measures are being implemented and how staff experience those changes so managers can act accordingly.

Keywords:
Health personnel/psychology
COVID-19
Qualitative research

Topics:
Professional issues
COVID-19
Critical care

Did this work require ethics approval? Yes

Institution: Clínica Alemana Research and Clinical Trials Unit

Committee: Facultad de Medicina Clínica Alemana Universidad del Desarrollo

Ethics number: Registration number 2020-78