Junior nurses in Kauvery Hospital on the frontline against the COVID-19 pandemic

N. Gethsial Kiruba^1,*, D. Kavitha²

¹Senior Executive, Quality and Training, Kauvery Hospitals, India

²Manager, Clinical Governance and Quality, Kauvery Hospitals, India

*Correspondence: Tel: +91 9791417858; email: gethsialkiruba@gmail.com

Abstract

The Coronavirus disease (COVID-19) is a major global public health emergency affecting more than 120 million people worldwide, resulting in more than 2 million deaths across 199 countries. The World Health Organization (WHO) declared COVID-19 outbreak as pandemic in March 2020. Since then, the nurses fighting on the frontline face several challenges including critical shortage of nurses, medical supplies, and a variety of mental challenges such as burnout and fear of infection. As the disease is evolving, these findings will aid the nurses to combat the pandemic with more resilience. Thus our review will explore the key issues the nurses facing during COVID crisis.

Background

Globally, healthcare systems faced tremendous challenges in combating the COVID-19 pandemic. Social distancing is the most effective method to contain the disease. However, this is not easy for healthcare authorities to implement. For instance, general wards were set up as isolation wards, and nurses and other front-line healthcare workers without infectious diseases expertise were assigned to step up and provide care for people with COVID-19 [1]. Frontline healthcare professionals were vulnerable to infection due to direct contact with COVID-19 patients. In order to mitigate the risk of viral spread and cross-infections among patients and staff within the clinical settings, further measures, such as suspending elective surgeries, were also taken [2,3].

Nurses comprise the major part of medical workforce. Due to their commitment to save lives, they had to come in direct contact with COVID affected patients. Nurses had limited time to be prepared before receiving a substantial influx of high-acuity patients, and in navigating new plans of care. However, nurses began working relentlessly on the front line of care, and in large numbers, irrespective of specialty. Among the nurses deployed to manage people with COVID-19 were nurses with limited expertise or experience in infectious diseases. They found themselves suddenly working in entirely unfamiliar and stressful environments, and exposed to significant risk [4]. By the end of October 2020, more than 1500 nurses worldwide had lost their lives to the virus [5]. Regardless, nurses have consistently demonstrated during these turbulent times commitment and compassion, often in the face of misinformation and adversity.

The nurses are playing a pivotal role in treating the COVID-19 patients as the nurses are the ones performing implementing the isolation policies, providing care to the patients, communicating with the families, providing health education on prevention against coronavirus and handling patient condition in this prevailing COVID crisis.

Nurses – The ‘Unsung heroes’

Though advised by her mother not to go for COVID duties, Mary Merlina, chose instead to fight against COVID for the sake of her patients and her country. She continued to convince and provided reassurance to her mother about the impact and importance of her commitment to profession.

Mary spoke: “Being a novice nurse it was very difficult for me to wear PPE for almost 9 hours without having time for my personal need to drink water or to use the washroom. During my internship I had only the experience in handling pediatric patients. But due to shortage of workforce I started handling adult patients as I wished to help”

She continued “One of my adult patients, when discharged to home, had said “When my relatives, and even my wife, were afraid to come near me, you took care of me very patiently, and with concern, without any hesitation”. He said that he won’t forget me in his lifetime and he blessed me to live for 100 more years of life. For these words, I felt that I can continuously work wearing PPE to take care of COVID patients”.

Coping Mechanisms

Mary and her peers had worked continuously for a period of 15 days, on 9 hours shifts, night or day, in a COVID ward. Most of the new nurses were not willing to work in the COVID ward initially due to fear of acquiring disease from COVID patients and their families were not willing for it.

But as the situation worsened, and as number of COVID patients increased exponentially, some young nurses needed to be persuaded while some others volunteered to be in frontline.

They stated, like Mary did “Being a nurse we cannot sit and watch people die”

Compassion and care

Nurses are the ones who spend most of the time with the patients. Effective communication, positive attitude towards patients and families enhance quality of care. Thus, compassionate behaviour towards the patients and families’ builds trust and cooperation from patients and their families.

“When I was told to do COVID Duty for only 4 days initially, I did it. But at the end of 4th day came a twist; four babies got admitted diagnosed with COVID. Then I was informed that I need to do my duty for 15 full days in the COVID ward. It was really a great shock for me to look at the babies suffering from this deadly disease.”

That’s the feeling shared by Karthika, Pediatric Junior Nurse from Trichy Cantonment.

Karthika says: “The level of fear among patients, patients’ attenders, staff and even among the staff’s relatives, our parents and families was the most challenging during this period.”

Difficulties in using PPE Kits

With the formidable challenge to the healthcare system, the personal protective equipment (PPE) provides protection to the healthcare professionals. But there are several problems associated with the use of PPE including dehydration, skin damage, excessive sweating, fogging of goggles and infrequent use of restrooms for prolonged hours.

COVID warriors

The nurses had fears of infection and death as well as fears of infection spreading to their loved ones. Higher self-efficacy, resilience, work willingness and active caring for patients during COVID crisis among the nurses demonstrated their high leadership qualities.

With the second wave, the situation became so much worse than before. As there was increase in number of patients, there was shortage of nurses as well. Each one of the nurses took care of about 14-15 patients during each shift. The nurses had experienced burnout, anxiety and fear. The nurses still expressed their willingness to work in the COVID crisis.

Conclusion

Our nurses experienced a variety of challenges in the COVID pandemic. They also faced stigma from neighbours and relatives. Our nurses have emerged as a strong frontline healthcare workers and they play a crucial role in combating COVID-19. They are not only providing care to the patients but also communicating with the family extending their care to them. Also they play a vital role in working with other healthcare professionals in achieving quality healthcare to the patients with COVID-19.

Thank you, dear nurses, for your service to humanity. We are so grateful to you. Also, we are so proud of you.

References

Liu Q, Luo D, Haase JE, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health. 2020;8(6):e790-8.
Phillips MR, Chang Y, Zura RD, et al. Impact of COVID-19 on orthopaedic care: a call for nonoperative management. Ther Adv Musculoskelet Dis. 2020;12:1759720X20934276.
Teoh JY-C, Ong WLK, Gonzalez-Padilla D, Castellani D, Dubin JM, Esperto F et al. A global survey on the impact of COVID-19 on urological services. Eur Urol 2020;78(2):265-75.
Catton H. Global challenges in health and health care for nurses and midwives everywhere. Int Nurs Rev 2020;67(1):4-6.
International Council of Nurses. ICN confirms 1,500 nurses have died from COVID-19 in 44 countries and estimates that healthcare worker COVID-19 fatalities worldwide could be more than 20,000. Available from : https://www.icn.ch/news/icn-confirms-1500-nurses-have-died-covid-19-44-countries-and-estimates-healthcare-worker-covid.