|CONCEPT AND ISSUE
|Year : 2020 | Volume
| Issue : 2 | Page : 117-121
Unrecognised roles of nursing professionals and midwives in mitigating COVID-19 pandemic across all spectrum of continuum of care
Sukhpal Kaur1, Rajavel Saranya2, Murugan Sathiabalan2, Soundappan Kathirvel3
1 Lecturer National Institute of Nursing Education (NINE) Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
2 Senior Resident Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Assistant Professor Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||04-Dec-2019|
|Date of Decision||22-Dec-2020|
|Date of Acceptance||23-Dec-2020|
|Date of Web Publication||19-Feb-2021|
Dr. Murugan Sathiabalan
1264, First Floor, Sector 15B, Chandigarh
Source of Support: None, Conflict of Interest: None
Every year, the World Health Organization (WHO) celebrates World Health Day on 7th April marking the foundation day of the WHO in 1948. The theme for the year 2020 is 'Support Nurses and Midwives' to mark Florence Nightingale's bicentennial year. Globally, the nurses and midwives comprise more than 50% of the health-care workforce. They are one of the important health human resources needed to achieve the Sustainable Development Goal on health and well-being by 2030. The services include promotive, preventive, curative and rehabilitative health-care services covering the whole spectrum in the continuum of care. The midwives primarily provide the primary health-care services primarily at community level. Similarly, various cadres of nurses deliver various healthcare services primarily at the facility level. During the Coronavirus disease- 2019 (COVID-19) pandemic the frontline Health Care Workers (HCWs) like nurses and midwives play a vital role in breaking the chain of transmission and providing supportive care to the suspected and confirmed COVID-19 patients. This manuscript describes in detail, the unrecognised roles of nurses and midwives in prevention and control of COVID-19 across all spectrums of continuum of care. This can be identified at community and health facility level from providing health education or behaviour change communication, screening/surveillance (active or passive), contact tracing, clinical care, mental health support, hospitality services, inventory management, monitoring/supervision of personal protective equipment use and biomedical waste management, isolation ward and quarantine centre management, recording and reporting and follow-up of patient/population.
Keywords: COVID-19, management of COVID-19, roles of nurses and midwives
|How to cite this article:|
Kaur S, Saranya R, Sathiabalan M, Kathirvel S. Unrecognised roles of nursing professionals and midwives in mitigating COVID-19 pandemic across all spectrum of continuum of care. Indian J Cont Nsg Edn 2020;21:117-21
|How to cite this URL:|
Kaur S, Saranya R, Sathiabalan M, Kathirvel S. Unrecognised roles of nursing professionals and midwives in mitigating COVID-19 pandemic across all spectrum of continuum of care. Indian J Cont Nsg Edn [serial online] 2020 [cited 2021 Mar 9];21:117-21. Available from: https://www.ijcne.org/text.asp?2020/21/2/117/309859
| Introduction|| |
Every year, the World Health Organization (WHO) celebrates World Health Day on 7th April marking the foundation day of the WHO in 1948. This day is being celebrated with a health-related theme for generating awareness. The theme for the year 2020 is 'Support Nurses and Midwives' to mark Florence Nightingale's bicentennial year. In 1854, Florence Nightingale was deputed by Britain to manage the wounded soldiers. She recorded the mortality rate and observed many of them died because of infectious diseases. With her simple intervention of providing a clean environment, clean water and fruits to the wounded soldiers, the mortality rate decreased from 60% to 42%. This incident made the world to understand the importance of nursing, and thus, the current modern nursing has been found. International Council of Nurses defined nursing as 'autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings which includes promotion of health, prevention of illness and the care of ill, disabled and dying persons'. The provided definition encompasses both nurses and midwives who may differ in their place of working (community/health facility), skill level (general/advanced), type of services (preventive/clinical/rehabilitative) or the serving population (whole population/women/children/a group of patients) based on their education level and experience.
Globally, nurses and midwives comprise more than 50% of the health-care workforce. They are the one of the important health human resources needed to achieve the Sustainable Development Goal on health and well-being by 2030. Hence, the World Health Assembly has designated 2020 as the 'International Year of the Nurse and the Midwife'. The services include promotive, preventive, curative and rehabilitative health-care services covering the whole spectrum in the continuum of care. The midwives (also known as community health workers [CHWs]) such as auxiliary nurse midwives (ANMs) or multipurpose health worker and village health nurse or Accredited Social Health Activists (ASHAs) primarily provide the primary health-care services primarily at community level. Similarly, various cadres of nurses delivering all types of health-care services primarily at facility level, namely, primary, secondary and tertiary care level. The spectrum of services is broad covering the reproductive, maternal and child health services, communicable and non-communicable diseases.
| Coronavirus Disease-2019-Continuum of Nursing Roles|| |
Coronavirus disease-2019 (COVID-19) is a highly contagious disease caused by a newly discovered coronavirus named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 spreads through respiratory droplets when an infected person coughs or sneezes or contact through fomites. Most people infected with this virus may experience mild-to-moderate respiratory illness and recover without requiring special treatment. The transmission of SARS-CoV-2 can be mitigated by practising good personal hygiene measures such as frequent hand washing, following respiratory etiquette during coughing and sneezing, maintaining physical distance and home quarantine or self-isolation of the infected or suspected persons. The WHO has declared SARS-CoV-2 infection as pandemic on 11th March 2020. The WHO is playing a major role by (a) addressing public daily, (b) describing the roles and responsibilities of health-care workers (HCWs), (c) providing the situation reports and various guidelines and (d) best practices for effectively containing the transmission of SARS-CoV-2 infection in addition to action taken by the respective country governments. More than 200 countries in the world are suffering from the current COVID-19 pandemic. In this pandemic, the frontline HCWs such as nurses and midwives play a vital role in breaking the chain of transmission and providing supportive care to the suspected and confirmed COVID-19 patients. This manuscript describes in detail, the unrecognised roles of nurses and midwives in prevention and control of COVID-19 across all spectrums of continuum of care.
The role or contribution of the nurses and midwives in prevention and control of COVID-19 can be identified at community and health facility level from providing health education or behaviour change communication (BCC), screening/surveillance (active or passive), contact tracing, clinical care, mental health support, hospitality services, inventory management, monitoring/supervision of personal protective equipment (PPE) use and biomedical waste management, isolation ward and quarantine centre management, recording and reporting and follow-up of patient/population. The provided services cover nearly all aspects of primordial, primary, secondary, and tertiary prevention in mitigating COVID-19.
| Health Education or Behaviour Change Communication|| |
Nurses and midwives play a major role in providing information, education and communication (IEC) or BCC regarding the techniques of hand washing and maintaining hand hygiene, proper and regular use of face masks, alleviating the stigma amongst patients, population and amongst HCWs, maintaining physical distancing and practising cough etiquette including preventing spitting in public places both at community and facility level. All the above-mentioned practices are part of standard infection prevention and control (IPC) practices applicable to any settings in the control of communicable diseases. They are also providing demonstration on hand washing/sanitising and proper use of PPE for the HCWs. In addition, they are educating the suspected or laboratory-confirmed COVID-19 patients and their family about the importance of disinfection and lockdown to break the chain of transmission, identification of danger signs and symptoms and instructions to be followed during home/facility-based quarantine. They (especially the nursing professionals) are involved in preparation of IEC materials and webinars to educate patient/population/other HCWs. They are also sensitising the beneficiaries regarding various social security measures announced by the centre and state governments and are coordinating or collaborating with Gram Panchayat, Self-help groups/Mahila Mandals and local non-government organisations (NGOs), youths and volunteers in awareness generation about COVID-19.
| Active and Passive Surveillance for Coronavirus Disease-2019 Cases|| |
Midwives or CHWs are involved in active, house-to-house survey to identify suspected patients at community level using prescribed format. Further, they are keeping a continuous vigil in their respective community to detect new suspects and transport them for testing and further care at designed hospital. Similarly, the nurses at health-care facilities screen and assess the risk amongst all patients availing outpatient/inpatient/emergency services for COVID-19 and link them for testing. In some places, they are also involved in telescreening for COVID-19 at population/facility level. They do provide mental health support to patients until results and later also. The patient with negative test results is linked with either facility-based or home-based quarantine centres, and the test positive patients are moved for clinical care at isolation ward or intensive care units (ICUs) based on the severity of the disease.
| Contact Tracing of Coronavirus Disease-2019 Case|| |
Irrespective of the place of testing, nurses and midwives are involved in tracing the contacts complemented by each other and screen (conventional or digital mode) the contacts for symptoms. Based on the presence of symptoms, they are linking them for testing or for home- or facility-based quarantine.
| Quarantine Centre Management and Follow-Up|| |
Individual or family with the exposure to COVID-19 cases or international travel to disease prevalent countries and test negative patients are quarantined at a facility or at home (based on local guideline) and followed up. Primarily, nursing professionals manage these quarantine centres, especially managing the inventories, monitoring PPE use, disinfection, biomedical waste management and other IPC measures and providing hospitality services to the residents. Importantly, they do daily screening (conventional/digital mode) of the people under quarantine and report the same to respective authorities. They are also providing supportive care such as mental health support and alleviate the stigma for the people/family under quarantine. They are also assessing the need of the patients with other chronic comorbidities such as diabetes mellitus, hypertension and asthma and ensure the regular supply of medicines for them.
| Triage Area Management and Care|| |
The nurses are involved in triaging the patients routinely as part of the team. They are providing clinical and supportive care in triage area and facilitate in mobilisation of the patients to respective wards or places for further management within and outside the hospital. Usually, mild-moderate COVID-19 cases are managed at isolation wards at COVID care centre or dedicated COVID health centre, respectively, and severe cases at ICUs of dedicated COVID hospitals.
| Clinical and Supportive Care of Coronavirus Disease-2019 Patients at Isolation Ward|| |
At isolation ward-mild-to-moderate coronavirus disease-2019 cases
The nurses are providing all clinical care as part of the team to COVID-19 patients admitted in isolation wards. Besides clinical care, they are ensuring (a) clean and hygienic environment and surfaces by following appropriate IPC measures, (b) physical distancing of beds (at least one meter) and (c) changing the bed linen and other hospitality services. As part of the care, they are monitoring (a) vitals, (b) input and output including medicine and food, (c) clinical status and (d) mental health regularly. They are providing counselling to patients and their family members regarding the clinical condition and prognosis and helping to reduce the fear or stress or stigma amongst them. Recently, the midwives or CHWs are entrusted with managing the mild and uncomplicated COVID-19 cases at home, and the detailed guideline on the same is yet to be released.
At intensive care units-severe coronavirus disease-2019 cases
The advanced practice or critical care nurses are providing the clinical and supportive care to severe COVID-19 patients admitted in ICUs. They are closely monitoring the clinical progression of the patients and providing basic/advanced life support based on the situation. Further, they are continuing their services at step-down units and follow-up post-discharge. In case of terminally ill patients, they are providing 'end of life care' which include physical, emotional, social and spiritual support. They are also assisting the critical care team in testing any new drugs or strategies for clinical improvement as it is a novel disease. In case of death, they are facilitating the safe management of dead body, i.e., preparing and packing the body for transfer from a patient room to an autopsy unit, mortuary, crematorium or burial site to respect the dignity of the dead, their cultural and religious traditions.
| Delivery of Essential and Emergency Services other than Related to Coronavirus Disease-2019|| |
Due to lockdown and reorganisation (temporary or permanent) of health systems, the routine non-COVID-19-related services are put on halt except for emergency services and antenatal services. The nurses and midwives are providing all emergency and antenatal services, respectively, at facility and community level. Amid travel-related difficulties and stigma/discrimination, the midwives or CHWs are visiting their community and providing health-care services in addition to COVID-19-related services. Recently, the routine immunisation services are also resumed, and they are providing the same to all children and pregnant women who are due for the same. As the CHWs are working closely with local residents and leaders, NGOs, social activists and other community stakeholders, they are acting as a bridge between them and the health facility or the policymakers in alleviating the fear, stigma and discrimination related to COVID-19.
| Recording and Reporting|| |
Like period before COVID-19, they are recording and reporting all the data in the prescribed format. The recording and reporting is related to providing health education, active or passive surveillance, testing and its results, contact tracing, quarantine centre management, clinical care, follow-up of patients/population and other administrative processes. These data are further used or can be used for coordinated and informed decision-making at the hospital, regional, state and national level.
At this time, especially related to this COVID-19 crisis, they are facing multiple challenges which need to be addressed timely for smooth and efficient delivery of services. The challenges are, namely,
- As the number of COVID-19 cases rising exponentially, the HCWs face various issues such as exposure to infection, long working hours, psychological distress, fatigue, occupational burnout and stigma. All HCWs should be oriented on established occupational safety and health procedure of the health facility. The hospital administration must ensure the adequate supply of PPE and provide the HCWs with proper PPE and safety gears for those involved in managing suspected or confirmed COVID-19 patients. Nursing professionals should be updated about the recent changes in testing strategies, screening, isolation, quarantine, treatment and triage procedures as per local guidelines. Global reports suggest that there is an acute shortage of PPE even in high-income countries such as the United States of America and the United Kingdom. Similarly, HCWs experienced high rates of infection and deaths due to COVID-19 which might be due to no/low access to PPE. The WHO calls on industry and governments to increase the manufacturing of PPE and ventilators by 40% to meet the rising global demand
- There is a chance of transmission of SARS-CoV-2 infection to the family members of the HCWs and further to community if they reside along with the family members after their duty hours. The daily duty hours for the nurses should not exceed more than 6–8 h, and the duty rotation for nursing staff should be for 7 days and after the 7th day, they should be quarantined for a period prescribed in the local guidelines. The hospital administration should provide accommodation for the nurses who is on duty and who is undergoing quarantine in a dedicated hostels or hotels for the prescribed duration with all basic requirements
- The administration should also provide various supports, appreciation to the HCWs in the form of insurance, financial incentives or professional incentives who are engaged in a tough battle against COVID-19. For example, the Government of India introduced 'Pradhan Mantri Garib Kalyan Package': Insurance scheme for HCWs fighting COVID-19 in government hospitals, to provide an insurance cover of Rs. 50 lakh for 90 days to a total of around 21.12 lakh public health-care providers including cleaners, ward boys, nurses, paramedics and CHWs, namely ASHAs and ANMs. In the current scenario, the insurance coverage should be expanded to all HCWs irrespective of the service is directly or indirectly related to COVID-19
- Ensuring safe and secure working environment at facility and community level. Appropriate security services need to be provided in addition to educating the community.
Despite challenges, the nurses and midwives are serving the community. In addition to their contribution in all aspects of prevention and control of COVID-19 at all levels, they often (has the potential to) serve as leaders, educators, advocates and researchers, all in addition to their nursing roles. They can be involved in developing proactive strategies that can be rolled out efficiently during an emergency.
| Conclusion|| |
On occasion of World Health Day 2020, the unrecognised roles of nurses and midwives, especially their tireless contribution in mitigating COVID-19 pandemic need to be recognised, respected and duly acknowledged. As their horizon of working is keep on expanding, their capacity and skills need to be regularly upgraded and provided comparable incentives.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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