NHS Lanarkshire physiotherapists added a new emotional challenge to their work skills, by stepping into unfamiliar critical care roles to help tackle coronavirus.

Although respiratory physiotherapy staff undertake duties in an intensive care unit (ICU) regularly, during this challenging period a substantial number of physios volunteered to go into the life-saving facility to assist nursing and medical colleagues to treat patients who were critically unwell with COVID-19.

Along with colleagues from other allied health professional services such as dietetics and speech and language therapy, the physios donned full personal protective equipment to carry out their roles, helping patients at University Hospital Hairmyres, University Hospital Monklands and University Hospital Wishaw.

NHS Lanarkshire head of physiotherapy services Claire Rae said: “I’m immensely proud of the team, who faced up to the harsh emotional challenges of working in ICU as the virus escalated and, sadly, saw patients lose their lives to the disease.

“Some colleagues were there as part of their normal duties, which include ‘mobilisation’ of ventilated patients, for example, helping them to sit on the edge of the bed or move into a chair. Others were new to the ICU or only worked there as part of their on-call duties.

“The situation was even more challenging for them all due to the need to wear full PPE.

“Working alongside the ICU nursing and medical staff, physios took on 12-hour shifts which included duties which are more associated with nursing staff, such as monitoring patients and helping with their personal care.

“They all had appropriate training from both their physiotherapy and nursing colleagues, and it was a measure of their commitment that physios who normally work in areas such as orthopaedics or women’s services had no hesitation in joining their colleagues who regularly work in critical care.”

The physios have now stepped down from their additional ICU duties, but training is continuing to ensure that across the three hospitals physiotherapy staff are available to add to the staffing complement to help out, in the same way, should there be another rise in coronavirus cases.

Claire added: “As part of their recovery after the physically traumatic experience of ICU, patients are treated by physios when they move to a ‘step-down ward’, as is anyone else treated in hospital for coronavirus.

“Rehabilitation is essential at this point to get individuals back to their normal level of function. We’re changing our ways of working because many patients experience extreme fatigue post-COVID, which means we have to use shorter therapy sessions, more often.”

CASE STUDIES

University Hospital Hairmyres

Orthopaedic physio Kathleen Longmuir hadn’t worked in an intensive care unit (ICU) for 20 years when she went back into the challenging critical care environment.

Kathleen, from Rutherglen, said; “I was out of my comfort zone, but I felt I had the skills to help and we had some intensive training.

“Two decades on, some things remained familiar, including ‘proning’ – turning patients on to their stomachs to help with their oxygen levels.”

The 12-strong physio team carried out regular duties such as chest physio for patients needing their passages cleared, optimally positioning patients and “mobilising” them where it was appropriate.

“There was some initial anxiety at first, but we were there for a month, and it became a normal job for us,” added Kathleen, who said she well trained and supported by ICU medics, nurses and managers, particularly in undertaking the aspects of personal patient care.

“This was an emotional journey for us all, working with such severely ill patients, not knowing what the outcome would be.

“We felt invested in all the patients, particularly when we would read the information about their lives before this illness happened.

“We’re prepared to step up again if there is a second wave of cases.”

University Hospital Monklands

Lorraine Senior is physiotherapy team lead for surgical and critical care so is used to the intensive care unit (ICU) environment, but coronavirus brought its challenges.

Lorraine, from Cumbernauld, said: “The highest number of coronavirus patients when I was there was 15, aged from their 20s to their 80s. We would typically know a lot about our patients, so it was very difficult not having their families visiting as this helps inspire people to get better.

“There were 12 physiotherapists in total, and we all did 12-hour shifts, day and night, for four weeks. Each physio was assigned a patient to look after which required us to assist in completing 24-hour observations charts, hourly fluid balance recording, adjusting and changing infusions of drugs under the direction of nursing staff, taking blood samples off for analysis, and personal patient care.

“In our traditional roles we were still providing chest physio to those patients needing help to clear sputum from their airways, and assisting teams to turn patients onto their stomachs, which helps improve their oxygen levels, as well as optimally positioning patients and mobilising them where it was appropriate.

“The emotional toll in ICU was far higher than usual. It amazed me how responsible you felt for the patient due to nursing them for 12 hours at a time as we usually rehabilitate patients for an hour a day. Nursing staff deal with end-of-life care regularly and this was one aspect that was more difficult for the physios to experience.

“One patient who recovered in ICU told me she had paid a special tribute to a patient in another bed. Sadly, he did not survive, so in tribute, the lady named her walking frame after him – she said that he was coming home with her to help her meet her rehabilitation goals.”

University Hospital Wishaw

As a physio in surgical and critical care, Rachael Wilson is used to the intensive care unit (ICU) environment, but coronavirus brought its challenges.

Rachael, from Livingston, West Lothian, was one of a team of four who spent a month doing 12-hour shifts in the unit to boost the usual staff numbers.

“Physios came from the musculoskeletal service, obstetrics and gynaecology joined us even though it was unfamiliar territory for them,” she explained.

“For our nursing tasks, we were given excellent training by the critical care nursing staff and assigned a patient. We’d work through the patient’s observations of their condition and looking after their personal care. It was a very different challenge being the main person working on a one-on-one with somebody over a prolonged period.

“For physio duties, we would mobilise patients – getting them to sit on the edge of the bed or getting them up and into a chair while on the ventilator. It’s physically demanding and having PPE on increases the time it takes and also means the patient can’t see the friendly face behind the mask and visor.”

Speaking about the emotional toll, Rachael added: “There were times that things didn’t go as well as you wanted. It came in waves and some days there weren’t good outcomes for our patients, so it was a unique experience and more challenging than our normal working day.”