key: cord-0923771-m88k4pjx authors: Nahidi, Shizar; Sotomayor-Castillo, Cristina; Li, Cecilia; Currey, Judy; Elliott, Rosalind; Shaban, Ramon Z. title: Australian critical care nurses’ knowledge, preparedness and experiences of managing SARS-COV-2 and COVID-19 pandemic date: 2021-05-12 journal: Aust Crit Care DOI: 10.1016/j.aucc.2021.04.008 sha: 93f82bbe1b7c320e6d9a433b1d3496dd7586626e doc_id: 923771 cord_uid: m88k4pjx BACKGROUND: COVID-19 has again highlighted the crucial role of healthcare workers in case management, disease surveillance, policy development, and healthcare education and training. The ongoing pandemic demonstrates the importance of having an emergency response plan that accounts for the safety of frontline healthcare workers, including those working in critical care settings. OBJECTIVES: To explore Australian critical care nurses’ knowledge, preparedness and experiences of managing patients diagnosed with SARS-CoV-2 and COVID-19. METHODS: An exploratory cross-sectional study of Australian critical care nurses was conducted between June and September 2020. An anonymous online survey was sent to Australian College of Critical Care Nurses (ACCCN) members to collect information about their knowledge, preparedness and experiences during the COVID-19 pandemic. Descriptive statistics were used to summarise and report data. RESULTS: A total of 157 critical care nurses participated, with 138 fully complete surveys analysed. Most respondents reported ‘good’ to ‘very good’ level of knowledge about COVID-19, and obtained up-to-date COVID-19 information from international and local sources. To manage patients with COVID-19, 82.3% felt sufficiently prepared at the time of data collection, and 93.4% had received specific education, training or instruction. Most participants were involved in assessing (89.3%) and treating (92.4%) COVID-19 patients. Varying levels of concerns about contracting SARS-CoV-2 were expressed by respondents, and 55.7% thought the pandemic had increased their workload. The most frequent concerns expressed by participants were a lack of appropriate PPE and fear of the PPE shortage. CONCLUSIONS: While most nurses expressed sufficient preparedness for managing COVID-19 patients, specific education had been undertaken and experiential learning was evident. Fears of insufficient or appropriate PPE made the response more difficult for nurses and the community. Preparedness and responsiveness are critical to successful management of the COVID-19 pandemic and future outbreaks of emerging infectious diseases. Coronavirus disease 2019 , caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) began as a cluster of pneumonia-like cases identified in Wuhan, Hubei Province in China in late December 2019 (1, 2) . The World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern on January 30 th , 2020, and issued recommendations to all countries that they should review their preparedness plans, including active surveillance, early detection, isolation and case management and contact tracing to prevent further spread of COVID-19 (3) . Since January 25 2020, when the first case of COVID-19 was confirmed in Australia (4, 5) , the country has experienced significant challenges in containing the outbreak. The intensified pressure on the healthcare system as well as the societal and socio-economic impacts driven by long lockdowns and stringent public health measures have had a significant toll on Australian federal and state governments and a range of industries, organisations and communities (6) (7) (8) . The COVID-19 global health emergency highlights the importance of having an agile and robust emergency response plan that deploys sustained infection prevention and disease control to ensure the safety of patients and health professionals, particularly those who are patient facing such as those in infection prevention and control, infectious diseases, emergency care, critical care, public health and general practice. These and other health professionals perform critical functions including case management, disease surveillance, policy development, and the education and training of clinicians and support staff. Previous research that examined clinicians' experiences, knowledge and perception in various outbreaks including SARS-CoV-1 (9), Ebola virus disease (10) and Middle East respiratory syndrome coronavirus (MERS-CoV) (11, 12) , helped to shape Australia's outbreak containment plan, response and clinician preparedness for COVID-19. In the context of critical care practice, successful management of outbreaks of emerging infectious diseases could be greatly influenced by whether a preparedness plan has already existed, and if the ICU functions are effectively integrated with hospital-wide plans (13) . Learnings from previous outbreaks have highlighted the necessity for adherence to rigorous infection control practices, efficient management of staff and their exposure, and provision of sustained training and education for key clinical practices (14) (15) (16) . On this basis, examining clinician knowledge, preparedness and experiences of managing the COVID-19 response is anticipated to assist with successful outbreak management during the current pandemic and in future emerging infectious diseases situations. This paper reports the findings of an explorative study of critical care nurses' knowledge, preparedness and experiences of managing SARS-CoV-2 and COVID-19 in the Australasian healthcare setting. An exploratory cross-sectional study of Australian critical care nurses was conducted between June 3 2020 and September 3 2020. The study population was critical care nurses practising in Australia who held current membership of the Australian College of Critical Care Nurses (ACCCN). ACCCN is the peak national professional nursing association representing critical care nurses in Australia, with a membership of 1415 registered nurses. An anonymous online survey was generated using Research Electronic Data Capture An electronic survey link was distributed in an invitation email via ACCCN to invite members to participate in the study. Two follow up reminder emails were sent to members. Collected data were cleaned and exported into SPSS (IBM Corp. Released 2019, version 26.0) for analysis. Descriptive statistics were used to summarise sample characteristics and results. Answers to openended questions were managed in Microsoft Excel, and analysed using conventional content analysis technique (18) . The first author performed axial coding of the data, grouped comparable codes into one code, and generated the codebook. The codes were discussed within the research team, which led to emergence of the major themes that incorporated the significant challenges of critical care nurses during the COVID-19 pandemic. This study was approved by the Human Research Ethics Committee at the University of Sydney, Australia (HREC 2020/200). The survey was distributed via ACCCN to reach out the members of the college (1415 registered critical care nurses). A total of 157 responses were received from ACCCN members who J o u r n a l P r e -p r o o f Page 5 of 18 participated in the study and provided demographic information. After excluding those whose survey records were incomplete, the data of 138 participants were included for analysis. Table 1 summarises the key characteristic information of the sample. < insert Table 1 about here > The majority of critical care nurses rated their current level of knowledge about COVID-19 as Most participants (n=114, 83.8%) indicated that their workplace had COVID-19 guidelines and some form of outbreak response plan, and a large proportion of these participants (n=79/114, 69.3%) were 'moderately' or 'entirely' familiar with those guidelines and response plans. While the majority of these participants (59.6%) indicated that it was easy to adhere to guidelines and response J o u r n a l P r e -p r o o f Page 7 of 18 plans, some found it to be more difficult (n=16, 14%). A smaller proportion of participants (n=19, 14%) were unsure as to whether such guidelines and response plans existed in their workplace, and a few (n=3, 2.2%) stated that their workplace had no COVID-19 response plane or guidelines. The majority (n=117/131, 89.3%) reported working in settings where assessments of 'moderately' or 'extremely' stressed at work as a result of the current outbreak (n=58, 44.3%), compared with those who were only 'slightly' or 'somewhat stressed (n=54, 41.2%), and those who were not stressed at all (n=19, 14.5%). While a majority (n=95, 72.6%) indicated that their workplace provided support services (e.g., debriefing and/or staff psychological support services), only a small proportion of participants attended debriefings (n=30, 22.9%) and/or accessed psychological services (n=6, 4.6%). Those who used these services rated them useful (n=28/30, 93.3% for debriefing and n=5/6, 83.3% for psychological services). Participants were invited to list their most significant challenges during the COVID-19 outbreak. The most common challenge reported was in relation to PPE supply and use (n=31/131, Staff anxiety and mental exhaustion was the second greatest challenge (n=17/131, 13%), which was reported in association with increased stress levels and high burnout rates, as summarised in the following quote: The third most common challenge reported was the communication challenges (n=14/131, 10.7%). Poor communication between management and clinicians during the course of the outbreak was a common concern, as signified in the following participants' remarks: Since the start of this pandemic, critical care nurses have been heavily involved in managing and treating COVID-19 cases in all the states and jurisdictions (21, 22) . Our findings show that more than two thirds of critical nurses in this study were directly involved in caring for patients with suspected or confirmed COVID-19 in the country. The two dominant COVID-19 outbreak response activities of critical care nurses were in relation to PPE donning and doffing training, and provision of support for healthcare professionals. Notwithstanding the intense exposure and involvement in COVID-19 related activities, there appeared to be high levels of concern about contracting SARS-CoV-2 which was reflected in participants' coping practices and behaviours. For instance, some used emotion-focused strategies (e.g., reducing social contacts and avoiding communications about their involvement in caring for COVID-19 patients) to minimise the risk of negative reactions and potential discrimination from others. Some used the available resources provided in their workplace (e.g., debriefing and employee psychological support) to practice problem-focused coping techniques to counteract their anxiety and mental exhaustion. These are consistent with the findings reported in other studies in previous outbreaks (23, 24) . This paper identified several key elements in the domains of knowledge, preparedness and experiences of a group of Australian critical care nurses who were involved in managing COVID-19 patients. To the best of our knowledge, there has been no similar study with the same aims and scope. The sample size in this study prohibited sub-analyses which could have highlighted different challenges specific to work context. There was also likely to be some elements of selection bias among respondents, culminated by the convenient recruitment method and advertising the study via ACCCN. For instance, those who chose to participate in the study are likely to have more involvement and interest in COVID-19 outbreak management. Nevertheless, the findings reported in this paper provide insight into multiple key facets of practice of a cohort of Australian critical care nurses and can be used in planning for successful outbreak management during the current pandemic and in future emerging infectious diseases outbreaks. This study was an investigator-initiated research and did not receive financial support from funding agencies in the public, commercial or not-for-profit sectors. Page 15 of 18 J o u r n a l P r e -p r o o f Novel Coronavirus (2019-nCoV): situation Report-1. Geneva: World Health Organization A novel Coronavirus from patients with pneumonia in China WHO Director-General's statement on IHR Emergency Committee on novel coronavirus (2019-nCoV). 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ANZICS COVID-19 guidelines 2020 A critical care pandemic staffing framework in Australia Surge capacity of intensive care units in case of acute increase in demand caused by COVID-19 in Australia Healthcare workers emotions, perceived stressors and coping strategies during a MERS-CoV outbreak Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution The authors extend their sincere thanks to all the critical care nurses who participated in this study. We also thank the Australian College of Critical Care Nursing for their support of this study, and their assistance in distributing the survey to the college members. Authors have no conflict of interest to declare.