Right from Florence Nightingale in the Crimean War to Fatu Kekula who help treat Ebola patients in Liberia, nurses have been at the forefront of every healthcare crisis. They are the critical link in the healthcare system that not only helps people get back to health, but become the biggest support to the family of the sick.
Especially during this pandemic, the roles of nurses have changed with great responsibilities and with a lot of challenges. A typical day in the life of a nurse on the Covid war front is filled with great uncertainty and a constant marathon. Every single shift has the potential to be momentous, exhilarating, exhausting, energizing, or all of the above. On any given day, nurses can see people at their weakest and most vulnerable, or at their strongest and most resolute times. Moreover, a single breach in infection prevention practice can cause life-threatening infections to any patient, especially for critical Covid patients who are immune-compromised considering the use of steroids, raised blood glucose levels, and use of medications that suppress immunity. Nurses act as patient advocates to ensure that the right treatment reaches the patient in the right manner. They witness the results of life-ending injuries and illnesses with such regularity that they become par for the course. Yet, this just the tip of the iceberg.
The stories and experiences that nurses have had since the pandemic is beyond compare but the lessons learned are here to stay.
Lessons from the pandemic: Covid-19 pandemic has put the entire healthcare community in trial mode. A trial that tested each and every healthcare provider’s endurance and resilience. Nurses were no different. The challenges were many; but amid these challenges, healthcare has transformed itself to accommodate the dynamic needs of the community. Infrastructural and process changes like creation of specialized isolation units, negative pressure areas, availability and efficient utilization of manpower and PPE, frequent mock drills, patient flow management drills, etc., have been implemented to tackle even the most extreme situations smoothly.
Critical role in emergency care: Nurses are an integral part of the disaster management team. They are the ones who triage (sort) the patients on their arrival which requires the right knowledge and critical thinking, and depending on her assessment the doctors treat those patients first who require urgent attention & treatment. Nurses are vital in mobilizing resources, ensuring appropriate patient monitoring, and providing the right care to needy patients. Nurses are also a major part of decision-making when it comes to risk mitigation.
Building resilience: Doctors and nurses have braved various crisis situations hand in hand with much dedication throughout ages, but it is only after the pandemic that their true worth has emerged. Each young doctor and nurse, despite being overwhelmed with stress and anxiety, witnessing deaths every now and then, themselves getting infected, and even passing on the infection to their family, have not stopped coming back to work.
Nurses have started having bigger roles when it comes to patient care in Covid-19 units. Frequent rounds and monitoring, ensuring patient receives food and medications round the clock, risk prevention and mitigation, attending to doctors and following specific instructions, collecting blood samples, escalating warning signs, etc, places nurses on a higher pedestal of responsibility and accountability.
The biggest challenges faced were to be flexible with changing protocols, nurse training, and wearing PPEs for several hours together. Fear of being infected and infecting the near and dear ones added up to the tension and anxiety. Despite these, they did not lose spirit, they had to go on. This was one of the biggest healthcare crises the country had ever faced in many years. Most of the hospitals although having an Infection Control Unit, were still not prepared for a crisis of this magnitude. They had to be deft in learning and help others learn too. They had to handle patients and extremely frightened patient relatives who weren’t even sure whether they would see their people again and the burden of short staff, limited resources made matters worse. Having said that, the lessons from the pandemic have also empowered them.
Role of the nursing head in infection control: Infection prevention and control became a priority for healthcare staff across all areas of clinical practice. The nursing staff became a critical link in infection control. They had to formulate new protocols and update skills accordingly. This includes segregation of patients as per their clinical conditions, creating isolation units for Covid-19 positive and suspected cases, ensuring adequate availability of PPE for all healthcare staff, skilled manpower & resources, and the well-being of all healthcare workers by providing them with prophylaxis, nutritious food, and psychological support. So, this is one part of the planning and establishing Standard Operating Procedures (SOPs). The next step is the preparedness implementation that includes infrastructure and inventory planning to ensure all patients get the required medicines and oxygen or ventilator support. Strict protocols had to be followed by each and everyone entering the Covid units.
Nurses will have a bigger responsibility in epidemiology studies: As part of the community nursing programme, we are trained to partake in epidemiology studies. Indirectly in many ways, we do contribute to understanding epidemics, an outbreak which becomes an important element of disease management. But going forward, the role and responsibilities will increase. During this pandemic, nurses have already been involved in data collection and analysis, understand the disease patterns, peaks, and more. They identify and investigate the problem, formulate the causal factors and alternative interventions, and implement to prevent and control the problem, also evaluating the effectiveness of the intervention. They participate in data collection, data analysis, planning, implementation, and evaluation. They have an active role in the prevention and control of communicable diseases which include:
- Identify sources of infection and methods of spread of infection
- Health education of people in general
- Notification of Covid-19 to the health authority
- Teach and supervise other workers in surveillance activities
(Minimole Varghese is chief nursing officer, Fortis Hospital, Mulund and Mohini Chandrashekhar is chief nursing officer, Hiranandani Hospital Vashi, a Fortis associate. Views expressed are personal.)