Punctuated Entropy in the ICU During COVID-19: Team Nursing and Burnout

BackgroundThe novel demands on hospital capacity arising from the COVID-19 pandemic revealed already-existing systemic weaknesses. Intensive care units experienced a sustained surge capacity and were forced to introduce modified standards of care and practices.PurposeIn this article we use punctuated entropy as a conceptual lens to reveal the impact of the COVID-19 pandemic on Ontario hospitals by drawing attention to the cumulative impact of repeated disaster events on their capacity to recover.MethodsThis qualitative instrumental case study took place at a Medical-Surgical Intensive Care Unit in a university-affiliated teaching community hospital in a large urban center in Ontario, Canada. Twelve healthcare professionals from the ICU participated in in-depth semi-structured interviews.ResultsIn-depth interviews with healthcare providers revealed an already-vulnerable system and the disproportionate impact of COVID-19 on the nursing workforce, compounding pre- burnout and compassion injury.ConclusionThe structure of intensive care and the dynamics of collaborative practices within ICUs are subject to continual reconfiguration, potentially leading to punctuated entropy - a permanent state of a lack of capacity to recover. Disaster recovery planning in healthcare services delivery should not be focussed simply on navigating the 'temporary' effects of a single event, but rather on how the event interacts with the already existing 'pathological' state of the healthcare system. In this way solutions to longitudinal systemic problems in ICU healthcare delivery can be anticipated and plans for mitigation can be put in place.