COVID-NURSE. The development, testing and evaluation of a COVID-19 fundamental nursing care protocol: a randomised controlled trial

Lead Research Organisation: University of Exeter
Department Name: Institute of Health Research

Abstract

Nursing care is hugely important to people in hospital. Nurses help people with eating, drinking, going to the toilet, skin care, moving, keeping clean, breathing, communication and mental wellbeing. Nursing care makes a significant difference to the way people experience being in hospital and to their recovery. For people with COVID-19, their symptoms and the infectiousness of the virus poses unique challenges for nurses in delivering this care.

In this study we will examine the literature from previous viral outbreaks and undertake a survey of innovations from NHS clinical teams. We will work with patients, nurses, other health care workers and doctors to design specific nursing procedures for these patients. We will then undertake a type of randomised controlled trial called a 'rapid-cycle' trial, which will allow us to quickly test these procedures across an initial 18 NHS sites to determine their impact on patient experience, care quality, patients' ability to manage day to day activities, treatment outcomes and costs.

We will ensure our nursing procedures are acceptable and realistic for rapid NHS implementation, with guidance and education materials. We will ensure they could be adapted for care homes, patients with other conditions requiring isolation and to global health systems.

Technical Summary

Background: nursing care is a key determinant of patient experience and correlated with safety, clinical effectiveness, care quality, treatment outcomes and reduced overall service use. No evidence-based nursing protocols exist to address the unique challenges of nursing hospitalised patients with the SARS-CoV-2 virus.

Aim: to co-create and evaluate the impact on patient experience, care quality, functional ability, treatment outcomes and costs of a nursing care protocol specifically addressing the fundamental care requirements of hospitalised patients with the SARS-CoV-2 virus not invasively ventilated.
Methods: 2-stage mixed-methods programme, following revised 2020 complex interventions guidance, of: 1) rapid-review, survey, co-creation consensus development of a nursing protocol; 2) rapid-cycle cluster randomised controlled trial with embedded process and economic evaluations.

Deliverables:
1.Fundamental nursing care protocol for hospitalised patients with the SARS-CoV-2 virus not invasively ventilated, with proven effectiveness on patient experience, care quality, functional ability and treatment outcomes within 9 months of project inception.

2.Feasible, acceptable and 'implementation-optimised' protocol for widespread implementation, through co-creation and changes implemented during rapid cycle trial waves.

3.Adaptable protocol designed to be generalisable for environments such as care homes, patients with other conditions requiring isolation and to global health systems via knowledge gained in a process analysis of intervention fidelity, mechanisms, contextual factors and implementation.

4.Guidelines, education materials and strategies accessible via Health Education England, the Open University's FutureLearn web platform, and experienced NHS sites acting as training hubs for other health Trusts/care homes/global health systems.