Nursing contribution to cope COVID -19 infection with courage and compassion
Usha Banerjee, Navaneetha Rathina, Ramesh Sarin
Department of Nursing Apollo Delhi, Indraprastha Apollo Hospital, New Delhi, India
|Date of Submission||06-Jul-2020|
|Date of Acceptance||23-Jul-2020|
|Date of Web Publication||14-Aug-2020|
Department of Nursing Apollo Delhi, Indraprastha Apollo Hospital, New Delhi - 110 076
Source of Support: None, Conflict of Interest: None
The advent of COVID-19 pandemic has suddenly changed the world and influenced the nursing profession as well. Nurses were among the first group of “COVID duty frontline warriors.” We briefly report the organization of services for the management of COVID affected or suspected patients at Indraprastha Apollo Hospital. The experiences of some of the nurses are described, highlighting their various problems when caring for these patients.
Keywords: Challenges in nursing, COVID-19 infections, frontline workers
|How to cite this article:|
Banerjee U, Rathina N, Sarin R. Nursing contribution to cope COVID -19 infection with courage and compassion. Apollo Med 2020;17:197-9
Nurses work in complex challenging environment liable to professional risks when providing care to their patients. Amidst the lockdown during COVID-19 pandemic, they work relentlessly providing 24 × 7 care to participate in the management of COVID patients. With limited sleeping hours, extra responsibilities, and added pressure, nurses have been working tirelessly ever since the pandemic broke. They spend maximum clinical time at patient's side when maintaining their dedication and commitment.
| Management of Covid Patient at Apollo Hospital|| |
The heads of all departments and senior management team had an emergency meeting to plan and manage COVID-19 patients, when it was decided to create a flu clinic. This was set up in Porta Cabin opposite the Emergency Department. Initially, it included two intensive care unit beds and two general beds. This dedicated space was increased as required. The engineering department made the necessary changes in the structure.
A 6-h working shift for nurses had never been heavy under normal times. Now, in a 6 h of COVID duty with personal protective equipment (PPE), the nurses had to restrict their meal times and washroom use to adjust to the changed requirements. Adequate hydration, meal times, and rest period were assigned to ensure that their immunity was strong. They were housed in a separate area in the living quarters within the hospital complex where their basic needs and food were provided. A separate space was provided for their dining and they were not allowed to dine with their colleagues. A mock drill was conducted on March 22, 2020, and a road map was prepared and shared with all the staff who were assigned in COVID units. It was discussed and demonstrated where to receive and how to move the patients.
| Experiences of Nurses|| |
A realistic phenomenological research study was adopted to focus on staff to collect various types of information, including human actions, motives, and result. Phenomenological research design was used to showcase experience of nurses working in COVID units. Six registered nurses were selected using convenient sampling technique. They included a nursing supervisor, a charge nurse, a team leader, and three staff nurses working in COVID units at Indraprastha Apollo Hospitals, Delhi. Semistructured (open-ended) questions were developed and were asked to the nurses during in-depth interview. The questions were asked and responses were recorded during in-depth interview conducted while ward rounds or by telephone and through WhatsApp. Their responses were recorded and analyzed later. The interviews were conducted in May–June 2020. Their responses were recorded in a descriptive form.
Emotional challenge: “I miss the comfort of being at home with my parents, but when duty calls there is no way I would turn my back on it. The job of a nurse is not easy, as it drains one physically; it's a challenge for me emotionally and mentally. In times of a pandemic like COVID 19, we spend 6–8 exhaustive hours in a PPE, drenched in sweat all day on our feet taking care of the patient. But whenever I see negative results of my COVID patients it gives me a sense of satisfaction and the smiles on their faces pays off for all my hardships. We get the first hand exposure of the plight of the patient, some of them critically or terminally ill, we become support for their families who might be going through mental trauma. Amidst all this keeping our mental peace and emotions intact is a challenge. Being a nurse is a Challenging task, I have realised that this is more than just a profession for me. This profession has helped me overcome my fears, mental barriers and I have come out braver and stronger.
Every day in the wards we face different challenges with no choice but to overcome them. By helping others, I have become a stronger human being.”
Ever since this pandemic broke out, my job has been more challenging than ever. I have learnt how to work in an emergency situation. The marks on my face because of the N95 masks, that we wear every day for 6–8 h straight, are the marks of a warrior who gives her 100% in the battlefield to save mankind she claims.
Common nursing procedures done: Before starting our duty in this unit, the identified nurses were trained and briefed on protocols of donning doffing, handwashing, use of mask, and showers postduty, which is our usual mandatory routine. Common procedure we carry out are swab tests, vitals monitoring, ensuring a healthy diet for the patients, giving them medicines on time, and rendering basic need based care for all our patients. In addition, monitoring critical patients closely, the ones suffering from multiple comorbidities or are terminally ill, is busier task. Elderly patients with comorbidities and age-related problems add further nursing challenges that are difficult to deal and manage. In this pandemic, visitors are not permitted to stay and visit patients, without a family member to boost patients. Providing psychosocial support is extremely important to ease their worries and make them feel comfortable; prayers have been the only link for all of us to face each day and look forward positively.
The saddest part of my duty during this period is when I had to handle the dead bodies of my patients. We are all aware the humans are mortals and have to leave the world someday. This pandemic has created fear in the mind of all the diseased and their loved ones. It was very painful for me to face the family and their loved ones. Families could not control their sentiment and emotions when they lose their loved one's as we educate them that they are not allowed to touch, hug, kiss, or go very close to the body. Religious ritual post death is strictly prohibited for these patients. But being a social human being we understand and respect their emotions and do whatever possible from our side to fulfil their last wish. We ensure their loved ones are permitted to see the mortal remains for the last time guaranteeing the application of standard precautions to prevent contact infection, simultaneously counselling them to be strong to face the reality of the situation.
When asked if all your COVID-19 patients are on the ventilator? No, not all patients are on ventilator. Fortunately, the number of patients who need ventilator support has gone down, from the past 2–3 weeks as people are aware and coming to hospital as they see the symptoms and report earlier before deterioration. However, it is important that we need to monitor them meticulously as they may become critical any moment and need to announce code blue to call for professional exerts. Communication is a challenge with patients with ventilator support, but we have been very compassionate to all patients and their loved ones as we alley their anxiety and fear by talking to them asking doctors to clear their doubts and also keep them in light with their progress and deterioration. We have a smart phone which is used for video call as recommended that this has a positive outcome for patient recovery and family support as well.
We had a COVID positive pregnant mother who gave birth to a healthy baby, thanks to the administrative and operation theater support they have created an OT for COVID-positive patients keeping in mind patient safety, staff safety, and all infection control protocols. Fortunately, the baby was COVID negative and we had to separate both after birth. The mother was refrained to visit the child for 2 weeks until she was tested negative. During this period, we used to share all detail of the child; she saw her child through our eyes for the initial few days. Every little detail of the baby was relayed through video many times in the day.
How worried are you of getting infected yourself? The way this virus spreads, we are all under threat of getting exposed to it, but we cannot turn our backs, and continue to carry out our work. Support from our senior leadership team and mentors has ensured that we were adequately armed to fight the battle. Our weapons were varied. A course of Vitamin C and hydroxychloroquine was given, being the only known preventive agents. Vigorous training on Donning and Doffing of PPE was carried out. The procedures for infection control to prevent and manage secondary infection and communicable diseases were rehearsed. Documentation, sample handling, and ventilator management were again reviewed. Compassionate care that needs to be rendered at this hour of pandemic was made the standard of practice. The “red book” which was the holy book of COVID practice was updated from time to time with current policy and protocol.
The situation is so scary that every patient, colleagues, friend, and surface is a potential risk but the hospital has made multiple efforts to ensure safety of staff by providing PPE kits, training to use them as per the protocol, frequent sanitization of surfaces, and maintaining infection control in the premises. We are trapped by necessity behind our masks and face shield inhaling our own exhalation to save and protect ourselves from infection and take care of our patients. Besides, we are given protein-rich diet from our food and beverages department absolutely planned by the chief of dietitian. Sick rooms were created separately for COVID duty staff in designated COVID floors of the hostel as well in the other floors, for the non-COVID staff to take care of any staff with any minor illness during duty till certified fit. In COVID wards, any staff with a history of contact with COVID suspects who later turns positive was quarantined and tested as per the protocol. Provision for reporting to the flu clinic was always available if I was feeling sick. All staff joining duty postleave were tested and screened before assuming duty so with end-to-end support my fear was negligible. We have the laundry support for our change of clothes postshower, a mini bus to ply us to our rooms, and designated lifts that were disinfected daily as per the protocol. As a nurse working in Apollo Delhi, my organization and all departments are vigilant and compliant to protocols that I do not fear of danger that I will be a Covid positive patient, where such stringent good practices are followed.
Have any of your colleagues (nurses or doctors) got infected by the COVID virus? Yes, few of my colleagues have been infected largely those who were on long leave, very few from COVID and non-COVID units. We do not know the source of contact as our hospital follows all guidelines to control this pandemic. All have recovered and that is a positive sign for our further commitment. Our organization has always stepped in and given all necessary medical support to their staff assuring our safety at all times. We are fortunate that none of them was seriously sick. Revised arrangements were made for accommodation, food, quarantine, and duty break policy. Social isolation was made, even though it was a difficult issue. In this setup, communication was never a challenge in this mobile world, and it helped them to maintain social distancing. All their movements were restricted for their safety and safety of others. This practice of discipline added strength and confidence to their capacity to cope up with the challenges that were likely to come in their path.
Have you got your routine break from your duty? Attention was paid to the duty roster to prevent overstraining of staff.
Breaks as per government advisory have been part of our duty roster. The ratio of nurse:patient is 1:1 for critical patients on ventilator and 1:4 for stable patients. We work for 6-h shift for 14 days and had a break for 14 days. At present, we are having 6-h shift for 5 days and 1 day off with total 5 off/month. Staff strength is increased as per patient strength and admission in the hospital.
We get adequate time to rest and recuperate. However, once in the room, it is disheartening to think how to fight this global pandemic. A silent prayer for all and I get to realize that “this is what I am trained to do” and I will commit myself with zeal to achieve my profession calling and serve humanity.
What advice would you give to another nurse just starting to look after COVID-19 patients? These are tough times for us as well as the patients and we have to be extra empathetic. We have an added responsibility of ensuring mental physical, social health of the patients, and their near and dear ones.
What do you dream of doing the most, once the crisis is over? Take a few days off and spend some time with my family, it has been over 2 months since I saw them.
This is the “Year of The Nurse” declared by the WHO. The world is realizing that they are the “Angles on Earth.” The nurses working in COVID units face serious challenges but are content with the support they are provided by the organization. Every action is well planned, organized, and executed with perfection, which makes the working environment comfortable. However, the fear of unknown, fast spreading virus, lack of effective therapeutic agents, and nonavailability of vaccine lead to disheartening concerns. Isolation, wearing of masks, and social distancing being the only mode of prevention create big challenges for all health-care workers. The nurses have displayed unmatched dedication toward performing their difficult tasks of patient care with fortitude and disregarding their personal problems.
| Conclusion|| |
This report describes the challenges by the nurses, their commitment, dedication, and the leadership skills to participate in the care of COVID-infected patients. The considerable physical and emotional hardships faced by nurses when carrying out their work are mentioned.