Nurses’ perspectives of COVID-19 medical emergency team responses: A mixed-method study

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BACKGROUND: The COVID-19 pandemic had a sustained and profound impact on the nature and frequency of medical emergency team (MET) activation. Infection control measures in combination with heightened patient acuity increased the risk of delayed recognition of and intervention for deterioration. Evidence describing nurses' experience of triggering MET activation during the COVID-19 pandemic is scant. OBJECTIVES: The objective of this study was to explore ward and intensive care unit liaison nurses' experiences of caring for deteriorating COVID-19-infected patients requiring MET activation in the ward environment. METHODS: A convergent mixed-method design using an online purposefully developed, cross-sectional 39-item (5-point Likert scale) survey and semistructured interviews, was employed. Nurses working in designated COVID-19 wards (n ∼ 200) and intensive care unit liaison nurses (n = 18) who had attended or participated in an MET activation episode for a deteriorating COVID-19-infected patient were invited to participate. Survey data were analysed descriptively. Responses to open-ended survey questions and interviews were inductively analysed thematically following Braun and Clark's six-step method. RESULTS: There were 41 (22%) complete survey responses from nurses who had been registered for 10 (Q1: 5, Q3: 17) years. Most (n = 37, 75.5%) worked part-time. Ward nurses reported they were prepared to immediately escalate care, using goals of oxygen saturation levels lower than usual ranges and accepting a higher-than-normal respiratory rate range. Many nurses were concerned about COVID-19-infected patients having an unwitnessed respiratory arrest and struggled to frequently monitor vital signs. Five interviews were conducted. Four interview themes were emotional impact, education and preparedness, organisational support, and team dynamics. Collegial interaction between the MET and nurses at the bedside appeared to generate camaraderie and trust that led to perceptions of growth in learning and scope of practice via inclusive communication and decision-making. CONCLUSION: Nurses in COVID-19 wards adapted their goals of care. They felt relatively isolated at the point of care, but during episodes of acute deterioration, they felt supported, valued, and competent in the care they could provide.

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