The survey had the aim of exploring the impact of the COVID-19 pandemic on lung cancer and mesothelioma specialist nurses from January 2021, and health impacts on nurses from March 2020. The survey was devised by the Mesothelioma UK Research Centre, Lung Cancer Nursing UK, and Mesothelioma UK to follow on from two previous surveys1. The online survey opened on 27/10/21 and closed on 3/12/21. The survey included both closed questions (tick box options), and open questions (free text qualitative answers).
Summary of key findings and recommendations
Respondents
- 85 responses were received from lung cancer/mesothelioma nurses based in England (n=78), Scotland (n=5), and Wales (n=2). The sample includes a range of nursing roles, most frequently Clinical Nurse Specialists (87%, n=74).
- Most respondents were female (n = 80, 94%), white/white British (n = 82, 96%), and had been working in their nursing role for between one and ten years (n = 50, 59%).
Changes in work since January 2021: 74% (n=63) reported changes, with increased home working (70%, n=44); redeployment to cover covid-19 wards/services, or other service (40%, n=25); or volunteering to work in inpatient services (ad-hoc) or supporting covid-19 services (29%, n=18)
Changes in workload and care delivery in comparison to before the pandemic: Respondents reported increased workload to meet the changing care needs. Examples included providing more emotional and psychological support (71, 85%), and supporting family carers (68, 81%)
Virtual working used since January 2021 (not used prior to the pandemic): 98% (n=83) of the sample reported using new ways of virtual working, with telephone/video Health Needs Assessment, video consultations, and virtual education reported as the top three virtual ways of working perceived as having positive impacts on care.
Quality of care since January 2021 (in comparison to before the pandemic):
- 67% (n=57) reported not being able to provide the same quality of care to patients
- 41% (n=35) reported leaving “care undone” due to the pandemic (this is defined as required patient care that is either omitted or significantly delayed2)
- 86% (n=73) reported that their patients had experienced delayed diagnosis
- 90% (n=75) reported disruptions to primary care services for patients
- 64% (n=53) reported positive changes to quality of care because of the changes made due to covid-19
- The qualitative data explored the reasons for poorer care, and the following four themes were identified:
| Covid restrictions | Impact of virtual working | More patients and patients in greater need | Stretched services |
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“The most difficult and least satisfactory care has been that available for our inpatients who have been isolated with covid either at the point of first assessment/diagnosis or shift to palliation. This is particularly true for carers…” (respondent 72) |
“…I feel the reduction in F2F contacts does impact the ability to build therapeutic relationships, pick up on non-verbal cues and has reduced access to support services” (respondent 15) |
“Sheer volume of patients, poorlier on presentation. Complex family needs” (respondent 69) |
“In January 2021 my colleague was redeployed which cut our nursing service by more than half” (respondent 62)
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The qualitative data highlighted rapid innovation to reduce negative impacts on patients:
“I think the pandemic has been a double-edged sword. On the one hand, we have been forced to review the ways in which we work and this is always positive- we have re-introduced some services that we had not been offering due to NOLCP job-planning, and these have been audited showing a positive effect for patients'' (respondent 72)
Impact of covid-19 on the health and wellbeing of respondents (since March 2020)
- Mental Health
- 83% (n=70) reported worry about exposing family to covid-19
- 66% (n=56) reported that their emotional wellbeing and mental health had deteriorated since the pandemic began
Factors influencing health and wellbeing were identified from the qualitative data with themes around the stress of increased workload, redeployment, and the emotional impact of the pandemic:
“I feel completely burnt out, unsupported and undervalued. I have had periods of crying where I have felt so low and stressed” (respondent 49)
- Physical Health & Fitness
- 47% (n=40) reported that their physical health and fitness was about the same as before the pandemic
The qualitative data highlighted issues of reduced access to exercise due to workload and protecting patients:
“Working more hours and doing everything you can to protect yourself from covid exposure means not attending gyms etc.” (respondent 77)
However, homeworking enabled others to build exercise into daily routine:
“…more routine - less travel and working from home and so have been able to build exercise into my day…” (respondent 39)
- The survey asked, “Is there a lasting memory that stands out?” The qualitative data highlighted both positive and negative impacts of the pandemic within the following themes:
| Concern for patients | Emotional impacts | Workload | Innovation | Team support |
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“Not having the same presence to patients. Unable to get back to patients and relatives in a timely way when they have questions / concerns.” (respondent 57) |
“The stress and anxiety of colleagues redeployed to Covid wards, tears and fears of the whole team and seeing the stress on otherwise previously positive and upbeat leaders” (respondent 42) |
feeling completely overwhelmed after having a day off and having 23 messages on the telephone from patients. And knowing I was the only one that would pick up the calls as I was lone working” (respondent 4) |
“I think it is has given us some opportunity to look at the service and make improvements. Also the use of virtual meetings and technology has improved how we deliver care” (respondent 44) |
“The support for each other in chat and other virtual facilities and the understanding of what colleagues have been experiencing has been so important . Helping to address and support each others fears and experiences” (respondent 6) |
Key recommendations
- The integration of virtual working into patient care should ensure that patient preferences are respected and virtual working should be undertaken with an awareness of inequalities in access to digital devices (the digital divide).
- Maintaining some face-to-face interactions with patients is important to ensure effective therapeutic relationships, patient assessments, and for the communication of sensitive information (e.g., breaking bad news)
- Compassionate proactive organisational and peer support should be provided to recognise and support nurses experiencing mental and physical health impacts due to the pandemic
- A strategic review of Lung cancer & mesothelioma services should be undertaken to explore barriers and opportunities to improving patient pathways resulting from the pandemic.
- Organisations should review staffing levels to ensure both patient and staff safety and avoid adverse impacts
Thank you to all the nurses who took part in the survey; and Lung Cancer Nursing UK and Mesothelioma UK for their funding for this study.