COVID-19: la necesidad de enfermeras de práctica avanzada en el cuidado de la salud

Lo que hemos aprendido del COVID-19: La necesidad de enfermeras de práctica avanzada en el cuidado de la salud. What we have learned from COVID-19: The need of Advanced Practice Nurses in Health Care.

COVID-19: the need of advanced practice nurses in health care

What we have learned from COVID-19: The need of Advanced Practice Nurses in Health Care. Lo que hemos aprendido del COVID-19: La necesidad de enfermeras de práctica avanzada en el cuidado de la salud.

Processo de enfermagem para pacientes com manifestações respiratórias da COVID-19 / Nursing process for patients with respiratory manifestations of COVID-19 / Proceso de enfermería para pacientes del COVID-19 con manifestaciones respiratorias

Objetivo: discutir sobre o Processo de Enfermagem diante dos aspectos clínicos respiratórios da COVID-19. Método: trata-se de um estudo qualitativo, descritivo, informativo que partiu de uma revisão narrativa da literatura, documentos da Organização Mundial da Saúde e das taxonomias aplicadas ao Processo de Enfermagem North American Nursing Diagnosis Association, Nursing Interventions Classification e Nursing Outcomes Classification. Realizou-se uma busca bibliográfica de artigos científicos que abordassem o tema na Biblioteca Virtual de Saúde e Biblioteca Virtual SciELO. Utilizaram-se descritores como: Coronavírus OR COVID-19 AND pessoal da saúde OR Enfermagem. Resultados: informa-se que diante da clínica apresentada, os principais diagnósticos são: Hipertermia, Padrão respiratório ineficaz e Troca de gases prejudicada. Ressalta-se que, para isso, são necessárias as intervenções de Enfermagem, as quais terão como resultado esperado a temperatura normalizada, conforto e padrão respiratório normal e a melhora na troca de gases. Conclusão: reconhece-se a importância do Processo de Enfermagem, o qual possibilita reconhecer as necessidades do paciente e atuar diretamente neles, identificando aqueles que forem prioritários e fortificando o cunho científico da profissão, padronizando uma linguagem própria e facilitando a comunicação entre os enfermeiros do mundo. (AU)

Objective: to discuss the Nursing Process in view of the respiratory clinical aspects of COVID-19. Method: It is a qualitative, descriptive, informative study that started with a narrative review of literature, World Health Organization documents and taxonomies applied to the Nursing Process North American Nursing Diagnosis Association, Nursing Interventions Classification and Nursing Outcomes Classification. A bibliographic search of scientific articles addressing the topic was conducted in the Virtual Health Library and the SciELO Virtual Library. Descriptors such as: Coronavirus OR COVID-19 AND health personnel OR Nursing were used. Results: it is informed that in view of the clinic presented, the main diagnoses are: Hyperthermia, ineffective respiratory pattern and impaired gas exchange. It is important to emphasize that, for that, it is necessary the nursing interventions, which will have as an expected result the normalized temperature, comfort and normal respiratory pattern and the improvement in gas exchange. Conclusion: recognizes the importance of the Nursing Process, which makes it possible to recognize the needs of the patient and act directly on them, identifying those that are priority and fortifying the scientific nature of the profession, standardizing its own language and facilitating communication among nurses worldwide.(AU)

Objetivo: discutir el Proceso de Enfermería ante los aspectos clínico-respiratorios del COVID-19. Método: se trata de un estudio cualitativo, descriptivo e informativo que se inició con una revisión narrativa de la literatura, los documentos de la Organización Mundial de la Salud y las taxonomías aplicadas al Proceso de Enfermería North American Nursing Diagnosis Association, Nursing Interventions Classification y Nursing Outcomes Classification. Se realizó una búsqueda bibliográfica de artículos científicos que abordaron el tema en la Biblioteca Virtual en Salud y Biblioteca Virtual SciELO. Se utilizaron descriptores como: Coronavirus o COVID-19 y personal de salud o Enfermería. Resultados: se informa que, a la vista de la clínica presentada, los principales diagnósticos son: Hipertermia, Patrón respiratorio ineficaz y Alteración del intercambio gaseoso. Se enfatiza que, para ello, son necesarias intervenciones de Enfermería, las cuales tendrán el resultado esperado de temperatura normalizada, confort y patrón respiratorio normal y mejora en el intercambio de gases. Conclusión: se reconoce la importancia del Proceso de Enfermería, que permite reconocer las necesidades del paciente y actuar directamente sobre ellas, identificando aquellas que son prioritarias y fortaleciendo el carácter científico de la profesión, estandarizando el lenguaje propio y facilitando la comunicación entre enfermeros en el mundo.(AU)

Hospital physical therapy management in pediatric patients with covid-19: case reports / Manejo da fisioterapia no âmbito hospitalar no paciente pediátrico com covid-19: relato de casos

ABSTRACT Objective: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. Cases description: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. Comments: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.

RESUMO Objetivo: Relatar as condutas fisioterapêuticas dos dois casos de pacientes pediátricos com COVID-19 internados em hospital de referência estadual em Porto Alegre para tratamento da doença. Descrição dos casos: Caso 1, sexo feminino, 10 meses de idade com doença crônica preexistente, internada desde o nascimento, utilizava ventilação mecânica via traqueostomia, evoluiu com hipoxemia, necessidade de oxigenoterapia e aumento dos parâmetros ventilatórios, sendo confirmada COVID-19. Foram realizadas técnicas de desobstrução brônquica e manutenção da expansão pulmonar. Além disso, a criança durante a internação adquiriu controle cefálico, sedestação sem apoio, rolar e alcance de objetos e durante infecção por coronavírus foram passadas orientações ao familiar para manutenção dos marcos motores adquiridos. Caso 2, sexo masculino, 9 anos, com doença psiquiátrica prévia e obesidade, evoluiu com quadro de rebaixamento do sensório e necessidade de tratamento intensivo, sendo o paciente colocado em ventilação mecânica invasiva na chegada à unidade e confirmada a infecção por SARS-CoV-2. Realizou fisioterapia para desobstrução brônquica, reexpansão pulmonar e mobilização precoce, apresentando melhora ventilatória ao longo da internação, e após 17 dias foi extubado com sucesso. Evoluiu de cinesioterapia passiva para assistida e resistida na internação pediátrica, conseguindo deambular sem auxílio, e teve alta hospitalar com condição funcional prévia à internação hospitalar. Comentários: A COVID-19 apresentou-se de forma distinta nos casos, todavia a fisioterapia foi essencial para a manutenção e recuperação do quadro funcional dos pacientes. Estudos futuros são necessários para melhor compreensão do curso da doença e suas repercussões funcionais, a fim de traçar um tratamento eficiente para os pacientes pediátricos acometidos pela COVID-19.

[Nursing Experience Caring for a COVID-19 Patient With Hearing Loss].

The focus of this article is on a male patient with hearing loss who was diagnosed with COVID-19 after returning to Taiwan from overseas. Due to the severe pneumonia infiltration, the patient received the clinical-trial treatment Remdesivir. In addition to facing the isolation and new-drug-related anxieties of the patient, the medical team faced difficulties in communicating effectively with the patient and in helping him through the isolation period. During the period of hospitalization (March 14th to April 13th, 2020), the author used Roy's adaptation model to perform a nursing assessment, which confirmed that the patient faced the following problems: (1) ineffective breathing pattern related to COVID-19, (2) impaired verbal communication related to hearing impairment, and (3) social isolation related to the isolation experience and the communication barrier with healthcare workers. During the nursing care process, the author helped the patient receive the antiviral treatment and taught him how to do diaphragmatic breathing in a comfortable, recumbent position to improve his breathing pattern. To reduce the difficulty of communication, the author made a pile of cards with common care-related words, provided pen and paper to write, and used a mobile-phone-based social-networking application to communicate with the patient. The author used writing to communicate with the patient and learned some simple signs from him to enable interaction. Moreover, the intervention helped him adapt to the isolation and treatment protocols to reach holistic nursing care. Based on this experience, the author suggests that hospitals cooperate with sign language organizations to teach healthcare workers simple communication skills, including sign language and cards to provide more complete care for patients with hearing loss during hospitalization.

[Experience Caring for a Severe COVID-19 Patient With ARDS in the Intensive Care Unit].

The author's experience caring for a patient with COVID-19 whose condition deteriorated rapidly into a critical illness in the negative pressure room of the intensive care unit is described in this article. The onset of severe acute respiratory distress syndrome led this patient to receive endotracheal intubation with mechanical ventilation and subsequent extracorporeal membrane oxygenation for life support. He was isolated in the negative air pressure room in the intensive care unit for infection control for this emerging respiratory infectious disease. This patient was also confronted with emotional pressures arising from the general uncertainty regarding the progress of this novel disease and from being isolated from the outside world. The care period was from April 5th to May 12th, 2020. The data was collected through direct care, written conversations, physical communication, observation, medical record reviews, diagnosis reports, and nursing assessments of physical, psychological, social, and spiritual distress. The health problems of this patient were identified as gas exchange disorder, infection, anxiety, and other problems. Our chest physiotherapy team comprised nurses, physicians, and respiratory therapists. After administering individualized treatments, including monitoring vital signs and installing an external life support system, the lung consolidation and lung collapse problems of the patient improved, allowing the ventilator to be removed. To address the patient's psychological problems, we used a humanoid diagram and whiteboard drawing as communication tools to explain to the patient the reasons for and functions of the different tubes on his body to reduce his anxiety and maintain the safe use of these tubes. Moreover, bedside care was replaced by mobile phone video and phone calls, allowing the patient to communicate with family members, which reduced his isolation-related anxiety and enhanced his compliance with treatment and care protocols. This experience supports the benefit of installing two-way video devices and viewing monitors in negative pressure rooms in the ICU to facilitate effective communications between patients, patient family members, and the medical team to reduce patient-perceived anxiety and social isolation. This case report provides a reference demonstrating a patient-centered caring model for treating COVID-19 patients in the ICU.

Desafios da enfermagem em uma unidade de transplantes ante a Covid-19 / Nursing challenges in a transplant unit in the face of Covid-19 / Retos de la enfermería en una unidad de trasplante frente a Covid-19

Objetivo: Conhecer a percepção dos enfermeiros que atuam em uma unidade de transplantes sobre os desafios de sua atuação ante a COVID-19. Método: Estudo descritivo e exploratório, com abordagem qualitativa, desenvolvido em uma unidade de transplantes de um hospital referência do Ceará, entre março e junho de 2020, por meio de entrevista. Os dados foram analisados pelo software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ). Posteriormente, foi realizada a análise fatorial por correspondência (AFC) e gerada uma nuvem de palavras para a qual foram consideradas as evocações que apareceram com maior frequência. Resultados: Participaram do estudo 14 enfermeiros, a maioria do sexo feminino. O conteúdo analisado foi categorizado em três classes: organização do fluxo de atendimento de casos suspeitos, equipamento de proteção individual no contexto da pandemia da COVID-19, o emocional ante a pandemia. Conclusão: Constatou-se que os enfermeiros sofrem ante as fragilidades relacionadas ao momento vivenciado, pois estão sendo cotidianamente desafiados a se adaptarem às mudanças em suas rotinas de trabalho.

Objective: To understand how nurses who work in a transplant unit perceive the challenges of their role in the face of COVID-19. Method: This is an exploratory, descriptive, qualitative study conducted through interviews in the transplant unit of a reference hospital in Ceará, Northeastern Brazil, between March and June 2020. Data were analyzed in the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ). Subsequently, we performed a correspondence factor analysis (CFA) and generated a word cloud, taking into account the evocations with higher frequency. Results: Fourteen nurses participated in the study, most of them women. The content analyzed was categorized into three classes: organization of the care flow for suspected cases, personal protection equipment in the COVID-19 pandemic context, emotional state in the face of the pandemic. Conclusion: We found that nurses are suffering due to fragilities related to the moment they are experiencing, as they are daily challenged to adapt to changes in their work routines.

Objetivo: Conocer la percepción de los enfermeros que laboran en una unidad de trasplante sobre los desafíos de su desempeño ante el COVID- 19. Método: Estudio descriptivo y exploratorio, con abordaje cualitativo, desarrollado en una unidad de trasplante de un hospital de referencia en Ceará, entre marzo y junio de 2020, mediante entrevista. Los datos fueron analizados por el software IRAMUTEQ (Interface de R pour les Analyses Multimensionnelles de Textes et de Questionnaires). Posteriormente, se realizó el Análisis Factorial por Correspondencia (AFC) y se generó un Word Cloud para el que se consideraron las evocaciones que aparecían con mayor frecuencia. Resultados: participaron del estudio 14 enfermeras, la mayoría mujeres. El contenido analizado se categorizó en tres clases: Organización del Flujo de Servicios de Casos Sospechosos, Equipo de Protección Personal en el Contexto de la Pandemia de COVID-19, La Emocional Frente a la Pandemia. Conclusión: Se encontró que los enfermeros padecen las debilidades relacionadas con el momento vivido, ya que diariamente se enfrentan al desafío de adaptarse a los cambios en sus rutinas laborales.

Mental health impact of admission to the intensive care unit for COVID-19.

The pandemic caused by Covid-19 has long term ramifications for many, especially those patients who have experienced an intensive care unit (ICU) admission including ventilation and sedation. This paper will explore aspects of care delivery in the ICU regarding the current pandemic and the impact of such on the mental health of some of these patients. Post discharge, patients will be returning to a very different community incorporating social distancing, and in some cases, social isolation and/or shielding. Many may experience a multitude of physical and mental health complications which can ultimately impact upon each other, therefore a bio-psycho-pharmaco-social approach to discharge, case management, risk assessment and positive behavioural support planning is recommended.

HOSPITAL PHYSICAL THERAPY MANAGEMENT IN PEDIATRIC PATIENTS WITH COVID-19: CASE REPORTS.

OBJECTIVE: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. CASES DESCRIPTION: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. COMMENTS: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.

Problems Encountered by Nurses Due to the Use of Personal Protective Equipment During the Coronavirus Pandemic: Results of a Survey.

The importance of personal protective equipment (PPE) for nurses in the global fight against the coronavirus disease-19 (COVID-19) pandemic cannot be overstated. PPE must be available, safe, and effective. There is increasing evidence that the use of PPE can cause physical health problems. PURPOSE: The purpose of this study was to further examine PPE-related physical problems experienced by nurses as well as the role of wear time on these problems. METHODS: Using a descriptive cross-sectional design, a survey was conducted among nurses working for state or university hospitals across Turkey who actively cared for patients with COVID-19. Survey questions included demographic variables, type of PPE used, physical problems experienced, and length of time PPE was worn (4 hours or less, or more than 4 hours). Descriptive statistics and logistic regression analysis were used to analyze the data. RESULTS: Three hundred and seven (307) nurses completed the survey. The most commonly reported problems were sweating when wearing a surgical (50.9%) or N95 (64.2%) mask, dry hands from wearing gloves (73.9%), perspiration when wearing overalls/gowns (84.1%), and vision problems when wearing goggles/face shields (47.9%). Logistic regression analysis indicated a signifcant relationship between > 4 hours length of use and the occurrence of the following: redness of the cheeks, dry mouth, redness of the nose bridge, and redness of the ears for N95 masks; dryness of the mouth when wearing surgical masks; skin dryness, sweating, and redness from wearing gloves; headaches from wearing goggles/face shields; and sweating when wearing overalls or a gown (P < .05 for all variables). CONCLUSION: The results of this study show that physical problems related to the use of PPE are common and increase when PPE is worn for more than 4 hours. The availability, safety, and effectiveness of PPE are crucial to help protect nurses. Studies to examine PPE quality, characteristics, efficacy, and optimal use are necessary to maintain the healthy workforce needed to care for patients during this pandemic.

Nutritional Care in Relation to COVID-19.

The following article was written after the initial wave of the COVID-19 pandemic in the UK. On reflection of clinical practice during this time, it was noted by the ICU team that the majority of ventilated patients appeared to have lost weight during their stay. Unfortunately, there was no ability to weigh patients during the pandemic, so this weight loss was a subjective observation. Regardless, this observation lead the ICU dietitian to retrospectively audit prescribed versus delivered feed. It was found that only 10% of admissions received the prescribed daily volume of feed within the first 7 days of admission. A further 6% of admissions were within 10% of achieving daily prescribed target volumes. The main reasons for this were proning patients, high gastric residual volumes and the overwhelming nature of the pandemic. Three areas of practice have been highlighted that will improve feed delivery should a second wave occur. 1. A nasojejunal team comprising 20 members of the ICU multidiciplinary team will be established to insert bedside nasojejunal tubes in all ICU patients on admission. 2. All proned patients will be enterally fed and practice adjusted as per British Dietetic Association recommendations. 3. The international enteral feeding guidelines regarding hypocaloric feeding for the first 7 days will not be followed due to minimal clinical evidence for the ICU COVID-19 demographic.

Animal-Assisted Support: Actionable Intervention for Burnout.

The impact of long shifts, the puzzling illnesses and manifestations of COVID-19, its personal and family impacts, and the sustained grief of many losses in the past 6 months requires consideration of interventions to lift caregivers' spirits. Burnout has long been a challenge for nurses working in intense acute environments. Today, the risk and effects are even greater. Animal-assisted support is one intervention that shows some promise in supporting employee well-being. [J Contin Educ Nurs. 2020;51(11):496-497].

A Cockeyed Optimist.

In the 1958 musical South Pacific, the character Nelly Forbush trills a song of optimism and hope amid the darkness of World War II (South Pacific Enterprises and Logan 1958). The chipper message of this fictional navy nurse might well be welcome amid the negative timbre of the pervasive political, cultural and societal upheaval that we are experiencing today - not to mention the burden of a global pandemic. The tune delivers the message of a so-called "cockeyed optimist," staying positive while many are not and being buoyed by the anticipation of brighter, sunny days ahead (South Pacific Enterprises and Logan 1958). COVID-19 has unloaded countless blows to virtually every aspect of the life we once knew; surely, this is enough to leave any cockeyed optimist reeling. Where do we find the strength of character to prevail during times like this? Somehow, good leaders do; finding creativity, courage and conviction to make the most of a bad situation, they rise above it. They show optimism in the face of fear, the unknown and circumstances beyond their control. Instilling abiding trust in their followers, they lead out of the abyss, shining light on new possibilities and opportunities.

Weathering Pandemic Turbulence: It's All about Relationships.

During my career, I have had many mantras, including "I love to wonder what will happen tomorrow" and "It's all about relationships." Well, I have been rewarded in spades because nothing has been predictable or stable about our professional practice environments since COVID-19 infiltrated our organizations. I have been challenged to develop and implement changes at The Hospital for Sick Children - a 300-bed tertiary pediatric academic health sciences centre in Toronto, ON - that we had never contemplated before. I believe that staying true to my leadership values and core principles has been essential when taking on such challenges and staying afloat during these tumultuous times.

Community Care and COVID-19: A Case Study.

Community Care City of Kawartha Lakes provides primary care through its Community Health Centre, a range of hospice services and numerous community support services. Along with other essential service providers, our organization has continued to operate throughout the pandemic. As a community-based health services provider, we recognized the imperative and the privilege for our organization and the larger home and community care sector to support individuals, especially those most vulnerable due to health status, socio-economic circumstances or isolation, to safely remain at home during the pandemic, in compliance with public health directives. This article describes the strategies and approaches we implemented along with reflections on the leadership practices and principles that emerged. It does not purport to be an exemplar for crisis management of the COVID-19 pandemic. Rather, it seeks to draw attention to the contributions made by community-based organizations and potentially serve as a case study for debate.