Abstract
OBJECTIVES: To explore the experiences of healthcare workers providing non-invasive advanced respiratory support (NARS) to critically unwell patients with COVID-19. DESIGN: A qualitative study drawing on a social constructionist perspective using thematic analysis of semistructured interviews. SETTING: A single acute UK National Health Service Trust across two hospital sites. PARTICIPANTS: Multidisciplinary team members in acute, respiratory and palliative medicine. RESULTS: 21 nurses, doctors (juniors and consultants) and physiotherapists described the provision of NARS to critically unwell COVID-19 patients as extremely challenging. The main themes were of feeling ill prepared and unsupported, a need to balance complex moral actions and a sense of duty to patients and their families. The impact on staff was profound and findings are discussed via a lens of moral injury. Injurious events included staff feeling they had acted in a way that caused harm, failed to prevent harm or had been let down by seniors or the Trust. Participants identified factors that mitigated adverse impact. CONCLUSIONS: Although many of the issues described by participants are likely immutable components of healthcare in a pandemic, there were several important protective factors that emerged from the data. Experience, debriefing and breaks from COVID-19 wards were valuable to participants and successfully achieving a peaceful death for the patient was often viewed as compensation for a difficult journey. These protective factors may provide modelling for future education and support services to help prevent moral injury or aide in its recovery. TRIAL REGISTRATION NUMBER: Registered on the Open Science Framework, DOI 10.17605/OSF.IO/TB5QJ.