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Care homes and COVID-19: study points to pressures nursing staff felt at height of pandemic

QNI survey reveals nurses took a stand against blanket directives on DNACPR
care home nurse wearing a face mask and visor talks to care home resident

QNI survey reveals nurses took a stand against blanket directives on DNACPR

A study has shed light on how care home staff felt under pressure to accept people with unknown COVID-19 status at the height of the pandemic.

One of the report's analysists said the lack of testing would have exposed residents and staff to heightened risk.

The Queen's Nursing Institute (QNI) research also revealed many care home nurses resisted directives not to resuscitate individuals made without discussion with residents, families or staff.

The QNI's survey of its 400-member care home nurse network, obtained 163 responses. Of these, 70 (43%) said their home had received a patient discharged from hospital in March or April who had not been tested for the virus.

A fifth of respondents (21%) said they had received a patient discharged from hospital who had COVID-19.

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QNI survey reveals nurses took a stand against blanket directives on DNACPR


Picture: Shutterstock

A study has shed light on how care home staff felt under pressure to accept people with unknown COVID-19 status at the height of the pandemic.

One of the report's analysists said the lack of testing would have exposed residents and staff to heightened risk. 

The Queen's Nursing Institute (QNI) research also revealed many care home nurses resisted directives not to resuscitate individuals made without discussion with residents, families or staff.

The QNI's survey of its 400-member care home nurse network, obtained 163 responses. Of these, 70 (43%) said their home had received a patient discharged from hospital in March or April who had not been tested for the virus. 

A fifth of respondents (21%) said they had received a patient discharged from hospital who had COVID-19.

‘The two worst weeks of my 35-year nursing career’

One nurse described a fraught period: ‘The two weeks of daily deaths during an outbreak were possibly the two worst weeks of my 35-year nursing career.’

Report author Alison Leary, professor of healthcare and workforce modelling at London South Bank University
Alison Leary  Picture: Nathan Clarke

Report co-author Alison Leary, professor of healthcare and workforce modelling at London South Bank University, said receiving patients with unknown COVID-19 status would have endangered residents and staff, with age being a risk factor for seriously illness.

She said: ‘If you look at the demographic in this report, 45% of the staff are over the age of 55.’

DNACPR decisions made without discussion with residents, families or staff

The survey, carried out in May and June 2020, showed 10% of respondents (16) reporting situations they found challenging, such as blanket decisions on do not attempt cardiopulmonary resuscitation (DNACPR) being made by GPs or clinical commissioning groups (CCG) without discussion with residents, families or care home staff; or decisions they opposed on legal, professional or ethical grounds.

One nurse answering a survey question on DNACPR decisions said: ‘We were advised to have them in place for all residents. We acted in accordance with medical advice and resident wishes, not as advised by a directive to put in place for all by a CCG representative. We challenged this as unethical.’

‘Nurses were powerful advocates for their residents’

Professor Leary commented: ‘They felt pressured to complete DNACPR decisions, many of which were blanket decisions. But many of them resisted… they actually acted as very powerful advocates for their residents.’

She highlighted how 39 respondents reported that COVID-19 had been a positive focus for change in how end of life care was discussed.

QNI chief executive, Crystal Oldman, said she was worried by the number of homes unable to access support from GPs, district nurses and hospitals.

‘These are universal health services. It is completely opposite to the protective ring around care homes that was being talked about at the time,’ she said.

Dr Oldman added that insights from nurses in the survey provided an opportunity to prepare for the support systems that may be needed for the anticipated second wave of COVID-19.


Find out more

The Experience of Care Home Staff During Covid-19 (QNI)


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