|
 
 |
| REVIEW ARTICLE IN NURSES' SECTION |
|
| Year : 2022 | Volume
: 3
| Issue : 3 | Page : 262-265 |
|
Highlighting the role of nurses: A reflection on COVID-19 pandemic
Rajesh Kumar
College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| Date of Submission | 12-Jan-2022 |
| Date of Decision | 04-Jul-2022 |
| Date of Acceptance | 18-Jul-2022 |
| Date of Web Publication | 28-Dec-2022 |
Correspondence Address:
Dr. Rajesh Kumar
College of Nursing, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JME.JME_4_22
The coronavirus pandemic brought new challenges and opportunities for health professionals, including nurses and nursing students. Nurses worked as front-line warriors to fight against COVID-19 worldwide. They worked round the clock to deliver the best possible care to critically ill patients admitted in critical care areas and use ventilators. Therefore, many national and international agencies, including the World Health Organization (WHO), the International Council of Nurses (ICN), and the United Nations (UN) body, have acknowledged the hard work of nurses during the pandemic. This document highlights nurses' diverse roles and responsibilities during the ongoing COVID-19 pandemic. Reflection on their work will further help policymakers support nursing professionals fighting against the virus and putting themselves at inevitable risk of coronavirus.
Keywords: Nurses, role, COVID-19, pandemic
How to cite this article:
Kumar R. Highlighting the role of nurses: A reflection on COVID-19 pandemic. J Med Evid 2022;3:262-5 |
| Introduction | |  |
On 21st December 2019, the first cluster of patients with 'pneumonia of an unknown cause' was identified and subsequently confirmed as a coronavirus or COVID-19 in the Wuhan province of China.[1] The virus spread rapidly and engulfed the world in the grip of infection. Based on these alarming levels of spread and severity, on 11th March 2020, the World Health Organisation (WHO) declared it a matter of international health concern and pandemic.[1] So far, in many countries, the 3rd wave of the pandemic is already at its peak, and other countries are passing through this serious crisis. Many health care workers, including nurses and the ordinary public, lost their lives in the pandemic. However, the impacts of different waves vary in India and globally.[2] However, in reply to a question by the government of India, it has been reported that 1509 health care workers who died in COVID-19 have been paid insurance compensation, later rejected by a former president of the Indian Medical Association.[3] However, some reports reflect the death toll of doctors but not nurses.[4] The intense suffering and loss of lives caught media attention nationally and internationally. Despite the deadly impact on healthcare workers, nurses working as front-line warriors outpouring much appreciation, love and gratitude from everyone worldwide.[5]
| The Role of Nurse | | |
Be it a common routine working or disasters, nurses always work on forefront and are responsible for providing round the clock providing holistic care for all types of patients.[2] Nurses are the largest workforce in the health care system of a country and are recognized as front-line workers to provide care during the pandemic.[2],[6] Nurses have involved various critical duties and responsibilities in the best interest of the individual and country per se. Further, nurses are expected to ensure personalised, high-quality and safe nursing care irrespective of their stage and degree of infection. They are also involved in other ancillary roles, including contract tracing and sample collection in pandemics which further augment the demand for nurses. Simultaneously, the nurses are also expected to maintain an adequate supply of sanitising stuff and personal protective materials.[7] It is known by now that the ongoing pandemic necessitates a large group of nurses in clinical management, awareness and public safety.
As per the American Nurses Association Code of Ethics for Nurses (2015), nurses are solely responsible for patients and have the same obligation to themselves and others. However, during an outbreak like a pandemic, both conditions may be jeopardised as nurses constantly work for the patients in the contagious zone and under depleted personal protective supplies or safety gear. However, nurses can determine how much service they can discharge while protecting themselves from pandemics.[8]
| Direct Care Provider | | |
Working as a front-line worker in the COVID-19 outbreak put the nurses at risk of infection. Nurses work in critical care areas involved in multiple life-saving procedures, including intubations and complex airway management of patients with COVID-19. While assisting a cardiac arrest patient and transporting critically ill patients, they must wear complete personal protective equipments (PPEs) to protect themselves. They were obliged and expected to maintain effective communication and coordination simultaneously. In addition, working in an intensive care unit, they should contact nursing services, cleaning services, infection control and other departments for smooth functioning and harmonised response. Looking after family members and assuring the health status of their patients is another principal duty for a nurse considering the infection control practices and further virus transmission.
Therefore, saving this largest yet most responsible health care workforce from infection is vital by making essential protective devices, including masks, robes, face/eye shields, gloves, gowns and aprons. However, using a unique way of teaching and training in their respective fields of work can further support and help the nurses fight one of the worst pandemics in history.[9] There are numerous methods used to train nurses to combat COVID-19 pandemic including, online video-module, one to one training, use of E-mails, online platforms, Dropbox or apps like WhatsApp groups.[10]
| Public Health Awareness | | |
Keeping citizens updated on transmission and prevention methods is an additional task that may help curb the infection or stop further transmission. So far, the public is in chaos regarding modes and methods of transmission of COVID-19 and needs extensive health education to mitigate the pandemic. Leaving these misconceptions and myths unattended may make the situation more complicated. As one of the most distinguished health team members, nurses play a crucial role in community awareness regarding transmission methods, infection prevention and subsequently in demystifying the myths regarding the pandemic. Further, this may help the public access health care services and adopt preventive strategies to reduce infection load.[11]
| Screening, Triage and Standard Precautions | | |
The COVID-19 pandemic thrust health professionals deep into the area of infection prevention. Compliance with standard precautions was proven the most challenging yet effective measure to combat the pandemic.[12] However, it is the most daunting task to implement and comply with infection prevention protocols and guidelines from time to time, as per the WHO and Centre for Disease Control and Prevention. However, the government also emphasizes infection prevention by imposing lockdown, following social distancing, universal masking, frequent hand washing, and environmental cleaning and sanitization. Similarly, nurses play a vital role in hospital and community settings by spreading awareness on prevention control.[7] Use of PPE, wearing mask, gloves and eye shield or respirator by health professionals, including nurses, receive media at national and international levels.
Pharyngeal swab collection was a critical step for detecting viruses in the human body. Trained nurses primarily carried out the sample collection since naso/oropharyngeal swab sampling required more skilled and trained nurses. Nurses deployed for sample collection underwent dedicated training before collecting it.[13]
| Nurse-Led Contact Tracing | | |
To stop further transmission within hospital and community settings, nurses played an unparallel job as a member of the contact tracing team during the COVID-19 pandemic. Contact tracing is teamwork involving notification about contacts from the screening department to notify further the family members or friends, or employees who came in touch with a positive patient. Their role was to collect the contact details of a COVID-19-infected patient, trace the suspected connections and make necessary attempts to stop transmission. Further, the team notified the person who contacted a positive patient and pick them up for the screening department adhering to PPEs. A necessary follow-up visit was also required to study the case progression. The role of nurses in contact tracing has been valuable in the pandemic. As key health team members, nurses played a flexible, responsive, accommodating and professional diligence during the pandemic to assist the infection control team in keeping patients, families and staff safe.
| Nurses in COVID-19 Mass Immunization | | |
The COVID-19 vaccine came as an extreme measure to curb the COVID-19 infection all around the globe; however, the efficiency remains to vary from one country to another, considering differing reasons not specified here. Nurses' involvement in all aspects of vaccination, from the collection, freezing, storing and delivery, plays a pivotal role in sudden boosting the vaccination rate.[14] Furthermore, nurses were actively involved in providing information and support services to develop educational resources to reduce vaccine hesitancy. Nurses' involvement in all the aspects of vaccinations, particularly in delivering vaccine information, is crucial in increasing mass vaccination rates and reducing estimated vaccine hesitancy.[15]
| Nurses in Breaking Bad News | | |
COVID-19 pandemic has taken away many lives which are not intended to end. In addition to delivering end-of-life care in fearful environments, nurses must also break the bad news to the patients and their relatives, often remotely, due to strict no-visiting policies. Breaking bad news is one of the most challenging tasks that require adequate knowledge, empathy, patience and expressive communication skills. Nurses play an essential role in breaking awful news by effectively communicating and gently handling relative or next of kin issues at the end of their life. Further, nurses help provide a comfortable place and susceptible climate to accept loss quickly.[16] Despite the uncertainties and fear of a pandemic, nurses played a remarkable job at the end of life in COVID-19.
| Research in COVID-19 Pandemic | | |
Nurses participated in different kinds of research during the COVID-19 pandemic. Nurses' research highlighted many burning issues in pandemics, including's awareness and practices on the coronavirus, the intention of health care professionals and the public to vaccinate, and different mental health issues faced by health professionals, including nurses and nursing students.[17],[18] Further, many studies explored the lived experiences of nurses and other health care workers during a pandemic. However, nurses can further explore cultural differences in the prevention and management of coronavirus pandemics to understand the virus's behaviour in different places.
| Taking Care of Vulnerable Population during the Pandemic | | |
The COVID-19 pandemic worsens health inequalities for the vulnerable population, including the elderly, pregnant women, children and migrants. Telehealth is delivering healthcare services by trained healthcare workers remotely using information and communication technologies. With rapid technological evolution and easy access to portable electronics, the public has at least one digital device, such as a smartphone. The use of video conferencing improves key to health care services while minimising direct transmission of the infectious agent from one to another person. Similarly, psychiatric nurses played a notable role in prioritising the unique needs of vulnerable people during the pandemic.[19] The strict social distancing norms made tele psychiatry services affable to provide counselling and other services during the crisis stage of pandemics.[20]
| Nurse-Led Training and Education | | |
To prepare nurses caring for the patient with coronavirus disease, nursing educators and faculty played a notable role in training fellow nurses on the proper use of PPE, infection prevention, airway management, use of a ventilator and different other aspects related to care of patients with COVID-19.[21] Timely and adequate education and training were need of the hour to minimise the risk of infection to nurses. Many expert nurses are deployed to provide care to critical patients. In contrast, others have been redeployed to the training wing to train and educate themselves on specific aspects of the pandemic before involving in patient care.[18] Further, it was important for nurses to update the training content per rapidly changing national and local guidelines on preventing and managing infectious diseases.
| Conclusions | | |
Nurses during the COVID-19 pandemic performed a tremendously good job of sensitising the public about COVID-19 symptomatology, methods of transmission, preventive measures and managing patients. During the pandemic, their role expands from ordinary nurses to the most proficient health professionals in the health industry. Their role was not limited to nursing care but extended to proper communication and coordination with other departments or sectors to stop the transmission of the virus. As we are uncertain and intimidating future with the worst yet to happen in some countries, it is early to say what lies beyond. We expect the nursing workforce to take a lead role in the pandemic and design a new working strategy to fight back against this situation. The current situation is complicated to comprehend and requires the collaboration of nurses with different other types of health professionals to win this unfinished war.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Hu Y, Chen Y, Zheng Y, You C, Tan J, Hu L, et al. Factors related to mental health of inpatients with COVID-19 in Wuhan, China. Brain Behav Immun 2020;89:587-93.  |
| 2. | Al Thobaity A, Alshammari F. Nurses on the Frontline against the COVID-19 pandemic: An integrative review. Dubai Med J 2020;3:87-92. |
| 3. | |
| 4. | |
| 5. | Bennett CL, James AH, Kelly D. Beyond tropes: Towards a new image of nursing in the wake of COVID-19. J Clin Nurs 2020;29:2753-5. |
| 6. | Buchan J, Charlesworth A, Gershlick B, Seccombe I. Critical moment: NHS staffing trends, retention and attrition. Heal Found 2019;1:1-38. |
| 7. | Fawaz M, Anshasi H, Samaha A. Nurses at the front line of COVID-19: Roles, responsibilities, risks, and rights. Am J Trop Med Hyg 2020;103:1341-2. |
| 8. | American Nurse Association. Nurses, Ethics and the Response to the COVID – 19 Pandemic. American Nurse Association; 2020. p. 1-3. Available from: https://www.nursingworld.org/coronavirus. [Last accessed on 2021 Jan 11]. |
| 9. | Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA 2020;323:1439-40. |
| 10. | Vera San Juan N, Clark SE, Camilleri M, Jeans JP, Monkhouse A, Chisnall G, et al. Training and redeployment of healthcare workers to intensive care units (ICUs) during the COVID-19 pandemic: A systematic review. BMJ Open 2022;12:e050038. |
| 11. | Sahoo S, Padhy SK, Ipsita J, Mehra A, Grover S. Demystifying the myths about COVID-19 infection and its societal importance. Asian J Psychiatr 2020;54:102244. |
| 12. | |
| 13. | Zhao H, He Y, Brister F, Yang L, Li G, Ling Y, et al. How can nursing teams respond to large-scale COVID-19 screening? Front Public Health 2021;9:681255. |
| 14. | |
| 15. | Miller ER, Shimabukuro TT, Hibbs BF, Moro PL, Broder KR, Vellozzi C. Vaccine safety resources for nurses. Am J Nurs 2015;115:55-8. |
| 16. | Sharma RP, Pohekar SB, Ankar RS. Role of a nurse in COVID-19 pandemic. J Evol Med Dent Sci 2020;9:2550-5. |
| 17. | Simonetti V, Durante A, Ambrosca R, Arcadi P, Graziano G, Pucciarelli G, et al. Anxiety, sleep disorders and self-efficacy among nurses during COVID-19 pandemic: A large cross-sectional study. J Clin Nurs 2021;30:1360-71. |
| 18. | Dharra S, Kumar R. Promoting mental health of nurses during the coronavirus pandemic: Will the rapid deployment of nurses' training programs during COVID-19 improve self-efficacy and reduce anxiety? Cureus 2021;13:e15213. |
| 19. | |
| 20. | |
| 21. | Baldwin S, Dowdican-McAndrew G, Clark-Maxwell A, Ellis T, Foley C, Hynes C, et al. The role of the clinical education team in the response to COVID-19. Nurs Times 2020;116:56. |
|
Search Pubmed for