Being a student on an Intensive Care Unit during a health pandemic

Prior to starting my placement on intensive care, it was the area of physiotherapy that I looked forward to most and I couldn’t wait to finally put my theoretical knowledge into practice. Due to current pressures the NHS is experiencing in response to the COVID-19 pandemic, I knew my placement may not be as I originally expected and with that, I had no idea what to expect. I am sure many of you are feeling the same.

In the days leading up to starting my placement, the media were emphasising the crisis the NHS was in with hospitals being at maximal capacity with very few intensive care beds available for those who may need them. This news obviously made me feel worried about what I may be walking into, the pressures the ICU team would be experiencing and whether I would become a burden to the team what with being a student.

Upon starting I felt instantly relieved to feel a part of the team and to learn that although the intensive care unit is very busy with critically unwell COVID-19 patients, they haven’t reached their maximal capacity and have staff being redeployed to support the team. My educator reassured me that although the situation is bad, it has been ongoing for almost a year now and the hospital has plans in place to cope with the demand. My educator also was supportive of my wellbeing and wanted to make sure I didn’t become overwhelmed working in intensive care. We agreed that managing my emotional resilience was a key learning outcome for this placement, as this is something that is likely to be affected during this placement.

It was initially a shock to see quite so many ventilated patients attached to several wires and devices keeping them stable and alive. I felt hyper-alert to the sounds of the monitors, and it was a very strange experience seeing so many members of staff but not able to see their faces or know what their roles were. It took some time adjusting to wearing full PPE and it was important to ensure I was well hydrated before entering ICU as I may be on the ward in PPE for hours before coming off.

Halfway through the placement, just as I started to feel comfortable on ICU, I then had to self-isolate which caused feelings of frustration and anxiety as I felt I was missing out on valuable clinical time to improve my practical skills and clinical reasoning. I used the time to further my knowledge by creating learning resources for future students and watching the respiratory update videos on YouTube hosted by Rachael Moses (AHP leader) which were very valuable, however I couldn’t wait to return to my placement.

Upon returning, I had a massive feeling of anxiety about not feeling part of the team again, missing out on learning opportunities whilst being off and that my clinical skills wouldn’t be as good as the other student who was also on placement with me. I found this very challenging and had to try focus on myself and my skills rather than worrying about what other people were doing.

One massive challenge throughout the placement was lack of time with my clinical educator. Due to their role, they were involved with organisation of the team, staffing and other responsibilities as well as supporting the ICU team, meaning that I did not spend much time them or receive regular feedback. This caused further anxiety as I was never entirely sure if I was doing well on the placement or what I needed to improve on, despite actively asking for either verbal or written feedback. Due to this, I tried to regularly seek feedback from any member of staff I did work with and complete regular reflections of my experiences and what I had learnt, as well as writing patient scenarios and treatment plans to demonstrate my understanding and clinical reasoning to my educator.

My advice to students going onto intensive care would be to ensure your educator is aware of your learning styles and how you like to receive feedback, if you are worried about this placement ensure you tell them this so that they can support you. Also ask if you can spend time with an intensive care nurse as they are so knowledgeable and will explain everything about the patient and their bed space which will help you feel more comfortable. Ensure you are proactively demonstrating your learning through reflections if you don’t have the opportunity to physically show your educator due to staffing or time pressures.

Most of all try not to put too much pressure on yourself and use this opportunity to get comfortable being on ICU, ask plenty of questions, observe other members of staff and practice your hands on skills as much as able to build confidence and the rest will follow!

Rachel Langton @physio_rachael