The hand-brain-heart connection: ICU nurses' experience of managing patient safety during COVID-19.
BACKGROUND
COVID-19 has challenged critical care nursing through increased critical care service utilization. This may have a profound impact on intensive care unit (ICU) nurses' ability to maintain patient safety. However, the experiences of ICU nurses in managing patient safety during an infectious disease outbreak remains unexplored.


AIMS AND OBJECTIVES
To explore ICU nurses' narratives in managing patient safety in the outbreak ICUs during the COVID-19 pandemic.


DESIGN
A narrative inquiry design.


METHODS
A purposive sample of 18 registered nurses who practiced in the outbreak ICUs during the COVID-19 pandemic were recruited between June and August 2020. Individual semi-structured interviews were conducted, transcribed verbatim, and narratively analysed.


RESULTS
Findings reviewed an overarching anatomy-specific storyline of a 'hand-brain-heart' connection that describes nurses' experience with managing patient safety during the COVID-19 pandemic. Firstly, stories on 'the hands of clinical practice' revealed how critical care nursing is practiced and adapted by ICU nurses during the pandemic. In particular, ICU nurses banded together to safeguard patient safety by practicing critical care nursing with mastery. Secondly, stories on 'the brain of psychosocial wellness' highlights the tumultuous impact of COVID-19 on the nurses' psychosocial well-being and how nurses demonstrated resilience to continually uphold patient safety during the pandemic. Lastly, stories on 'the heart of nursing' drew upon the nurses' intrinsic professional nursing identity and values to safeguard patient safety. Specific patient tales further boosted the nurses' commitment to render safe nursing care during the pandemic.


CONCLUSIONS
Through their stories, ICU nurses reported how they continually seek to uphold patient safety through clinical competence, resilience, and heightened nursing identity.


RELEVANCE TO CLINICAL PRACTICE
ICU nurses require sustainable clinical resources and references such as clinical instructors, as well as visible psychosocial support channels, for ICU nurses to continue to uphold patient safety during COVID-19.
['Lin|Yongxing Patrick|YP|https://orcid.org/0000-0002-1561-3307', 'Tang|Charmaine Jinxiu|CJ|https://orcid.org/0000-0003-2167-3362', 'Tamin|Vincent Aditya|VA|https://orcid.org/0000-0001-7851-8262', 'Tan|Lorraine Yee Ching|LYC|', 'Chan|Ee-Yuee|EY|https://orcid.org/0000-0001-8662-4487']
nursing patient safety COVID-19 critical care narrative inquiry