This blog is hosted by the Faculty on behalf of the UKCCNA. It’s content reflects the views of individual authors and not necessarily those of the FICM
I’m Natalie Pattison and I’m the deputy Chair of UKCCNA. I work in a joint role as a Clinical Professor of Nursing at the University of Hertfordshire and East and North Herts NHS Trust. My clinical focus is critical care and I lead the critical care recovery service and clinic at East and North Herts NHS Trust. The other part of my role is to develop clinical academic capacity across the two organisations. I also have the pleasure of working across other organisations like UK Critical Care Research Group and the National Outreach Forum.
I know I’m very fortunate to be working in a role where I can conduct research studies and then quickly put the findings into practice. An area I’m passionate about clinically is supporting patients to recover after critical illness to recover and I’ve worked in this area for over a decade. This past year we’ve seen a tangible shift in our work, with the advent of COVID-19 and consequences for over 15,000 patients who were admitted into critical care with COVID and were discharged home1. We’re used to seeing people who have been critically ill needing support in following months as they try to return to their daily lives, but the sheer volume of patients who were very critically ill has meant we’ve had to really try and step up the support they are offered. My qualitative research work from more than 100 patient interviews over the years, has outlined that recovering from critical illness leaves a huge legacy and that there are often immense difficulties in returning to a new normal. Yet, it is not all doom and gloom, and I can attest to the fact that numerous patients over the years have talk about how there is a reframing of priorities following critical illness that can actually be positive, not dissimilar to the concept of post-traumatic growth I’ve found in my research.
What is perhaps different with COVID patients is that over 80% of those admitted to critical care were not needing any help with activities of daily living beforehand. They are younger and were fitter before admission, but in critical care they become sicker than the ‘usual’ critical care patients seen. It will be really interesting to see and understand the long-term implications from these admissions, as they unfold and how it has affected their daily lives. These patients often have long-COVID symptoms, not dissimilar to the spectrum seen in post-viral fatigue, compounded by a recovery from a prolonged critical care stay and often with post-intensive care syndrome. We’ve had the NICE guidance to support COVID recovery last year, and Quality Standards for critical care rehabilitation, and while there is now NHS funding to support long-COVID clinics, it is a travesty that for a large proportion of critical care patients who weren’t admitted with COVID-19, their needs will not be addressed in a coordinated manner. However, one of the positive legacies in the area I work in, Hertfordshire, is the opportunity to work in a more cohesive and coordinated way and create integrated pathways for COVID patients from acute and critical care to downstream care in the community. I’m lucky to work with a specialist COVID-GP, and a huge range of allied health professionals and specialists from several Trusts in the area, all working to support long-COVID patients’ recovery. I really hope in the future that the fantastic coordinated response seen in some geographical areas with long-COVID services becomes the norm for people after critical care and that we have a pathway to support them and not a postcode lottery as it currently stands. We need a mandate to ensure people’s unmet needs following critical care are addressed, and pathways like we see in stroke, cardiac rehabilitation and other illnesses to support these people. Provision remains piece-meal at present.
Furthermore, we need more research into what services are needed for people and the ongoing sequelae of critical illness, and critical-COVID. In part this will be answered in part by some of the large scale NIHR studies like REGAIN, HEAL-COVID, PHOSP COVID, TLC and others in the UK, we are fortunate to have coordinated research responses to clinical questions about recovery. There remain a large number of unanswered questions about long-term legacies but we have to make the most of the opportunity to learn lessons from the rapid establishment of long-COVID services, such as coordination across Trust and regions, and think about how we can apply this working to critical care rehabilitation and recovery. This is a passion for many of us working in this area and I know we are starting to make some headway, but we to need join forces and apply pressure on policy-makers and commissioners to understand the scale of unmet needs. I believe this is the way we will be able to make a difference to our patients in the long-term."
"Hi, this month’s blog has more of a research focus. I’m Ruth Endacott, Professor of Critical Care Nursing for nearly 2 decades. I work at the University of Plymouth, the Royal Devon and Exeter Hospital and at Monash University in Melbourne (although that’s a bit out of reach at the moment..). I sit on the UKCCNA as a representative of the ICS. I have the privilege of sitting on the ICS Research Committee, where one of the key goals is to nurture early career researchers – so important!
Well, one gain from the pandemic is people are talking about research – I’m at last able to talk with family and friends about what I do at work and there are glimmers of understanding! We do know that having research studies going on in a Trust does make a difference to patient and organisational outcomes, maybe because it makes us think about our everyday practice a little differently. But those of us doing research are also very aware of the burden it can sometimes place on ICUs, particularly around recruitment time. So, a huge thank you, from the research community, to those of you who’ve been involved in the many studies currently underway in ICUs. We’ve been supported by the amazing network of Clinical Research Nurses, some of who were redeployed back into practice too.
It’s great to see results emerging from some of these studies – the sooner researchers can publish their work, the sooner it will have an impact on patient care. One of the things we discuss at UKCCNA Board meetings is the current research activity for critical care nursing going on across the country (and beyond). We’re keen to put researchers in touch with each other if they’re doing similar studies but also to make sure we promote dissemination activities. Follow us on twitter to stay in touch @UKCCNA also follow critical care nursing journals (@ICCNursJournal and @niccjournal) for the latest evidence."
"Hello all. I am Suzanne Bench, a Professor of Critical Care (Nursing) at London South Bank University and the current chair of the United Kingdom Critical Care Nursing Alliance (UKCCNA).This is my first ever blog so hope it is useful!
We hope that a regular UKCCNA blog will help people understand who we are and provide us with a way to share our vision of our role in shaping the future strategy of critical care. Over the coming months, you will hear each of our members talk about the key issues that they individually and the UKCCNA collectively are facing.
Let me start with the UKCCNA, which is the umbrella organisation for all critical care nursing organisations in the UK. Established in 2013, UKCCNA has nursing representatives from the Royal College of Nursing (RCN), the Intensive Care Society (ICS), the British Association of Critical Care Nurses (BACCN), the Paediatric Critical Care Society (PCCS), the Critical Care National Network Nurse Leads Forum (CC3N) and the National Outreach Forum (NoRF). The UKCCNA feeds into the multi-professional Critical Care leadership forum, currently chaired by Dr Carl Waldman and has a webpage currently hosted by the Faculty of Intensive Care medicine (FICM), where you can find more information about the UKCCNA and our work. Despite the uncertainty, fear and challenges the COVID-19 pandemic has imposed on our world, one positive thing it has achieved is to raise the profile of nursing in general and critical care nursing more specifically.
Never before have the skills and knowledge of critical care nurses been so much in demand.
Over the last few months, we have had numerous requests to represent nursing on national workstreams of important issues, including defining levels of care, workforce modelling, critical care education, and rehabilitation strategies, as well as many others. We have also been asked to endorse a range of guidelines produced by professional organisations and have produced our own position statement about nurse staffing. The wide representation within the UKCCNA enables us to have our ear to the ground and to act in a timely way, allowing us to actively seek out issues that we think are important and intervene when we believe we need to.
Having a collective critical care nursing voice has never been more important, not only to avoid duplication of work at a time when everyone is so busy, but also to ensure that we are providing a consistent message, which is heard at a national level and can influence the policy agenda. Having a ‘seat at the table’ is the first step to ensure that future changes are made with consideration to the impact they have on our nurses, as well as the wider multi-disciplinary team, and the patients and families that they care for. For too long, much of what we do as nurses has been decided by others, without adequate involvement of critical care nurses. UKCCNA’s goal is to ‘take that seat’, whether or not it is offered, and to ensure that we work together as a nursing group to represent the needs of critical care nurses across the UK.
As a clinical-academic critical care nurse and a NIHR 70@70 senior nurse research leader, I feel passionately that the UKCCNA should also contribute towards both designing and implementing research evidence within critical care and support critical care nurses’ involvement. I am therefore proud that the UKCCNA are the expert advisory group for the NIHR funded study (SEISMIC) led by our ICS representative (Professor Ruth Endacott). I’m even more proud that the original study idea originated from a literature review undertaken by the UKCCNA, and a subsequent request to Professor Endacott to take forward the work on our behalf.
We are always keen to collaborate with colleagues from across disciplines. If you would like to know more about our work or how you might get involved with us, please contact me on firstname.lastname@example.org"
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