How hospitals, Intensive Care Units and nursing care of critically ill patients have changed during the COVID-19 outbreak? Results from an exploratory research in some European countries

Introduction. During the Covid-19 outbreak, the health care institutions and the Intensive Care Units (ICUs) have been reorganized with significant consequences at both organizational and clinical levels. Aims. To investigate (1) the organizational changes of hospitals and ICUs in dealing with the Covid-19 outbreak; (2) the characteristics of the nursing care; (3) the most important challenges perceived by nurses in caring for Covid-19 patients. Methods. Cross-sectional online survey, available from May 11th and July 10th, 2020. Participants were nurses caring for Covid-19 patients in European ICUs. Results. A total of 62 nurses responded to the survey; average age 37.5 years, 31 ( 60.8%) were female, mostly from Italy, France and United Kingdom. All hospitals underwent many changes, such as the opening of new dedicated wards and the restriction of family visits. The number of ICU beds doubled during the pandemic (p<0.01), as well as the number of nurses per shift from 10.2 ( SD 7.3) before to 17.9 (SD 13.6) during the pandemic (p<0.01). However, changes in the nurse-to-patient ratio were not significant: from 1:1.5 to 1:2 (p=0.05). Among nursing care activities, clinical risk management (n=14, 22.6%), psychological support for patients (n=22, 35.5%) and family's involvement (n=31, 50%) resulted as more challenging; 64.5% of nurses suffered from protective equipment shortages, and 66.1% experienced psychological burden. Conclusion. These findings can help to reflect on how to better prepare both nurses and health care institutions for other events that may threaten clinical practice and require major and innovative efforts.