INTRODUCTION:

The outbreak of the novel corona virus (COVID-19) was in the month of December 2019 with an epicentre in Wuhan city of China. Many patients were admitted with the case of viral pneumonia and eventually led to rapid contagious conditions spreading globally¹. COVID-19 is declared an emergency pandemic disease and has affected millions of lives globally. Many developed and developing countries were in a health crisis due to health care system unpreparedness. The disaster had caused an economic downturn causing unemployment globally². Italy was massively affected by COVID-19 even after having disaster preparedness due to an abrupt increase in critical cases and has substantiated the need for meticulous intensive care³.

World Health Organization (WHO) declared that the practice of maintaining social distance of 6 feet due to its vulnerable contagious nature of COVID-19. Contact tracing for those people who come in contact with an infected person, need a home quarantine or institution quarantine, early diagnoses, monitoring and treatment⁴. Severely affected COVID-19 patient shows severe respiratory distress with hypoxia and needs respiratory support in the intensive care unit⁵. The author reviews the critical reflection on an emerging perspective of nurses and discusses the approaches and strategies to overcome the pandemic COVID-19.

Impact of COVID-19:

During outbreak of the COVID-19 pandemic the most vulnerable and high-risk population are those person with co-morbid conditions such as hypertension, diabetes, immune-compromised and developmental disabilities due to limited access to health care services⁶. COVID-19 comprises respiratory disease-causing pneumonia and needs close monitoring of oxygen saturation. Other symptoms include myalgia, fatigue, high temperature, sore throat, cough and gastrointestinal disturbances like diarrhea⁷. Some patients also reported a loss of smell and skin rashes. Severely infected patient shows hypoxemia, respiratory distresses, and altered level of consciousness which needs massive respiratory therapy and Cardio Pulmonary Resuscitation (CPR) or/with life support⁸.

A survey conducted on impact of coping mechanism on nursing students during lockdown infers that COVID-19 has affected nursing student's mental health leading to stresses, deprived sleep, and agitation with decreased coping mechanism⁹. The lifestyles of people changed after COVID-19 and led to limited social activities. Loss of life, fear of getting infected, fear of spreading among family members, and uncertainty of disease pattern also increased the psychological distress among the people¹⁰. Every new information regarding the virus needs to be updated regularly. This unique problem faced needs an updated Policy and clinical decision¹¹.

Contributions of Frontline Nurse Practitioners:

According to WHO, in 2015 approximately 400 million people do not access to primary health care services and shortage of nurses in more than 50% of countries. WHO has also declared 2020 as the International year of nurses and midwifery. With COVID-19 pandemic the biggest challenge faced by nurses, were recognized for their tremendous contributions in delivering health care services globally and gained trust and respect from the people globally. During the disaster of this deadly virus, COVID-19 cause uncertainty, lack of resources, unpreparedness, lack of human resources, vaccine on trials and no medical treatment leads to a crisis of the health care system¹². Nurses work with compassion and commitment during the crisis but due to lengthy exposure repeatedly in present health care settings resulted in a more vulnerable threat for infection as the virus is highly contagious¹³.

During the pandemic, one of the vital roles played by nurses as Advanced Nurse Practitioner (ANP) was appreciated with leadership quality and specialized in critical skills to assess, diagnosed, providing care in the acute and on-going treatment of the population. Nurse anesthesiologist plays a vital role and does a remarkable job with critical skills on airway management such as endotracheal intubation, administering oxygen with humidifier, connecting with mechanical ventilator with or without endotracheal intubation, continuously monitoring oxygen saturation, vital signs, level of consciousness, positioning and also arrangement for life support as required.

A study conducted in China to identify the preparedness of nurses during the COVID-19 crisis shows emergency preparedness with the highest score of 64.99 and factors associated such as education or training, behavioral control, confidential work in disaster effort and experience¹⁰. The lowest moral consideration was found in 3.4% of nurses and no moral consideration in 0.7%. Nurse researcher or scientists contributed by conducting innovative studies to create knowledge or evidence-based practice or best practices to be adopted in a clinical setting as monitoring inflammatory markers, the impact of stress on DNA and have supported many projects¹⁵. The nursing profession has adopted evidence-based practices and theory-based models. Roy's adaptation model can be effectively used to enhance the psychological well-being of nurses working during the COVID-19 pandemic¹⁶.

Critical Care Nurses at the Frontline:

Critical care nursing is a newly emerging speciality in the last two decades, intending to understand the complex process of critical care illness and care priorities. Expansion of infrastructure in Intensive Care Unit needs more development on policies and algorithms regarding care bundles. The recommended ratio of ICU Nurse and patient is 1:1, due to increased patients admitted in ICU, it changed to 1:3 majorly or 1:6 in some critical scenario¹⁷. Effective use of PPE protect from repeated risk of exposure. Face mask protects from respiratory droplet transmissions such as FFP1, FFP2, FFP3, N95 and among all N100 is considered most effective with filter capacities of 99.97%¹⁸.

Delirium is the most common problem which indicates the seriousness of the patient's condition admitted in ICU with respiratory support. The common causes of delirium is observed by a mnemonic I-WATCH-DEATH of Hypoxia, withdrawal, trauma, heavy metals, CNS pathology, toxins or drugs, acute vascular, deficiencies, acute metabolic, infections. Tools used commonly for assessing delirium are Confusion Assessment Method (CAM) and Confusion Assessment Method-ICU (CAM-ICU) Scale. Glasgow Coma Scale is used to check the level of consciousness. ICU care mnemonic such as ABCDEF Bundles, individualized care approach, educating family members and communication with patients are also implemented¹⁹.

Care for Vulnerable Groups:

The worldwide fatality rate of acute respiratory disease COVID-19 is 2% and 3.5 times more in immune-compromised patients suffering from cancer conditions²⁰. The most vulnerable groups with co-morbid conditions and developmental disorders are mostly affected due to the disease condition or therapies. A study conducted to assess the role of nurses caring for Developmental Disabilities (DD) reported an unclear scope or roles of nurses²¹. To decrease the effect among the vulnerable groups the government should develop policies for caring for Developmental Disorders people at the community, organizational, interpersonal and individual-level during a COVID-19 pandemic.

The frontline health care worker and high-risk people will be prioritized first for the distribution of vaccines as declared by World Health Organization (WHO). Several vaccines are being developed viz., Pfizer, Covaxin. COVAXIN is developed by Bharat biotech, Indian Council of Medical Research, National Institute of Virology²². Effective COVID Vaccine (WHO, GAVI, CEPI) proven to be safe will be accessible and equitable distributed among the people in all countries²³

Emerging Concept in Nursing during Pandemic:

The newly identified respiratory disease COVID-19 is tough to manage due to its rapidly changing pattern. The role of nurses focused on mainly five domains. The first domain covers high-risk groups by giving education, screening and public support. The second domain focuses on providing psychological support and infection control measures such as frequent hand washing, social distance and wearing a mask. The role of a nurse in the third domain is the protection of patients admitted to hospitals by reformulating visiting policies, training staff on early identification and prevention from infection. The fourth domain is protecting the co-morbid patients with the primary condition or immune-compromised as they have a higher risk for infections. The final or fifth domain is providing care for COVID-19 patients with a mild or serious condition in ICU settings and ensuring staffs protect themselves by increasing critical skills and knowledge by using effective PPE, manpower and other resources²⁴. The COVID-19 pandemic has shaken health care services globally. In the United States, more than 290000 NP's took the challenge and provided primary care services²⁵.

E-health is a sophisticated emerging concept in health care services, highly encouraged and practiced during the COVID-19 pandemic reaching remote areas and helps to maintain social distancing. Tele-nursing, tele-pharmacy, tele-surgery, isolation and supplies are all considered in tele-health. Technology has provided many benefits but also faces issues during its delivery such as 5G deployment, connectivity, privacy and securities issues²⁶. Shortages of nurses lead to changes in the full practice authority for Advanced practitioner register nurse(APRNs) without supervision by a physician and can independently prescribe drugs²⁷. Together, we can overcome these challenges or crisis and brings life to normalcy by taking adequate prevention, screening, isolation, public education, meeting the needs according to Maslow's hierarchy needs, and taking appropriate treatment.

Challenges and Limitation faced during Pandemic:

Nurses proved as true heroes of the pandemic, work with compassion, provide care in fear and have dedicated their life for patients care by taking risks. Nurses play a very significant role in managing the COVID-19 disaster. A maximum number of health care workers are represented by nurses, who act as frontline soldiers during the crisis. A survey conducted on the nurses preparedness for the pandemic by the American Nurses Association observed that maximum nurses (around 87%) were not prepared, 36% were worried due to inadequate PPE supplies and only 11% of them were fully prepared²⁸. Due to the uncertainty of disease pattern, nurses and health care workers faced many issues like inadequate manpower, training, infrastructure, resources, frequently changing protocols or policies, and lack of crisis management. According to a recent study, assess burnout and resilience among frontline nurses in emergency department of tertiary care centre in north India finds that 86% of frontline nurses fear spreading infections to family members and their colleagues²⁹. The burnout level found was moderate to high which needs an effective intervention to decrease burnout among the frontline nurses. Maslach Burnout Inventory-Human Services (MBI-HSS) survey for health personnel tool was used to measure the burnout and showed high in emotional exhaustion and depersonalization with lesser in personal accomplishments.

SUMMARY OR CONCLUSION:

COVID-19 pandemic is one of the critical challenges faced in the history of mankind and number of infection is rising day by day. Globally, the health care system must be kept in priority and needs a change in the existing system of the health care system. COVID-19 pandemic teaches a new way of living and makes us understand the importance of health. The significant role of nurses maximally contributed in facing the difficulties during a health crisis and nurse’s work with compassion, dedication and also their critical skills help to manage the current pandemic. Together we can win and overcome this virus if we follow all the protocols appropriately. All health care workers are working 24X7 without fear of infection and consequences.

CONFLICT OF INTEREST:

The author declares no conflict of interest.

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Received on 04.12.2023 Modified on 27.02.2024

Asian J. Nursing Education and Research. 2024; 14(2):137-140.

DOI: 10.52711/2349-2996.2024.00027