Right from Florence Nightingale in the Crimean War to Fatu Kekula who helped treat Ebola patients in Liberia, nurses have been at the forefront of any healthcare crisis. They are the critical link in the healthcare system that not only helps people recover back to health, but become the biggest support for the family of the sick.
During this pandemic, the roles of nurses have changed and brought great responsibilities and 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. 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 acts 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 regularity. Yet, this just the tip of the iceberg. The stories and experiences that nurse have had since the pandemic is beyond compare but the lessons learnt are here to stay.
LESSONS FROM THE PANDEMIC
This 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 transformed itself to accommodate the dynamic needs of the community. Infrastructural and process changes like the creation of specialised 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 and 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, getting infected, and even passing on the infection to their families, 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 patients receive food and medications round the clock, risk prevention and mitigation, attending to doctors and following specific instructions, collecting blood samples, escalating warning signs, etc., such tasks have placed nurses on a higher pedestal in terms of responsibility and accountability.
The biggest challenges faced were to be flexible with changing protocols, nurse training, and wearing PPEs for several hours together. The fear of being infected and infecting near and dear ones added to the anxiety. Despite these, they did not lose spirit; they had to go on. This is one of the biggest healthcare crises the country had ever faced in many years. Most 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 relatives who weren’t even sure they would see their people again. Moreover, the burden of short staff and limited resources made matters worse. Having said that, the lessons from the pandemic have also empowered nurses.
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-positive and suspected cases, ensuring adequate availability of PPE for all healthcare staff, skilled manpower and resources, and the well-being of all healthcare workers by providing them with prophylaxis, nutritious food, and psychological support. This is one part of the planning and establishing Standard Operating Procedures (SOPs). The next step is 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 program, 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:
• Identifying sources of infection and methods of spread of infection
• Health education of people in general
• Notification of Covid-19 to the health authority
• Teaching and supervising other workers in surveillance activities
Today, Infection Control Nurses are empowered to collect and analyze the data from Covid patients. They are the ones who collate and send data to local authorizes for notification of Covid patients. Mass sensitization drives are also helmed by nurses by actively taking part in webinars, online sessions in order to create awareness regarding the prevention and management of the infection.
Minimole Varghese is Chief Nursing Officer, Fortis Hospital, Mulund, and Mohini Chandrashekhar is Chief Nursing Officer, Hiranandani Hospital, Vashi, a Fortis associate.