Role of Nurses and Nurse Practitioners in the COVID 19 Pandemic
Please review the literature of all pandemics and how nurses/nurse practitioners played a role or not, what lessons were learned then and how they can be applied now. how they can be more proactive with now the covid 19 pandemic based on prior pandemics. Please a minimum of 10 references but can be more. Please do not do turn it in as I do not want a duplicate in the system when my institution uses their own turn but can utilize another form of plagiarism check where my paper will not be seen as a duplicate from someone else. If you need more time or if this can be done sooner, I am also flexible. Can be more pages based on what needs to be said. Below is an abstract I started, buy please feel free to change, add, delete. Thanks
Nurses and Nurse Practitioners (NP’s) have always been steadfast in their delivery of compassionate and empathetic care to those who are most in need. The coronavirus (COVID-19) pandemic has highlighted these altruistic attributes of caring, helping, and giving that are germane to nursing. Having witnessed many of these nurses and NP’s go beyond their call of duty and statutory responsibilities during the COVID-19 pandemic while knowingly putting themselves and their families at risk is praiseworthy. While admirable, many nurses and NP’s suffered greatly behind the scenes. Many had to work without adequate personal protective equipment (PPE), and in unsanitary conditions. Some were deployed to other units within the hospital and in new roles that were unfamiliar to them, while others worked undesirable shifts, and longer hours. Most nurses had families and children to go home to and had to make a choice between exposing themselves and their loved ones to COVID-19 and continuing to deliver selfless care that was oftentimes done in challenging conditions. How did they cope with this? What other struggles did they contend with? Did they have support systems in place? This paper will examine some of the challenges and encounters inpatient rural and urban nurses and NP’s experienced during the COVID-19 pandemic.
Role of Nurses and Nurse Practitioners in the COVID 19 Pandemic
Nurses and Nurse Practitioners (NPs) have always been steadfast in delivering compassionate and empathetic care to those most in need. The coronavirus (COVID-19) pandemic has highlighted these altruistic attributes of caring, helping, and giving germane to nursing. We have witnessed many of these nurses and NPs go beyond their call of duty and statutory responsibilities during the COVID-19 pandemic while knowingly putting themselves and their families at risk are praiseworthy (Schwerdtle et al., 2020). While admirable, many nurses and NPs suffered greatly behind the scenes. Many had to work without adequate personal protective equipment (PPE) and in unsanitary conditions. Some were deployed to other hospital units and in new roles that were unfamiliar to them, while others worked undesirable shifts and longer hours. Most nurses had families and children to go home to and had to choose between exposing themselves and their loved ones to COVID-19 and continuing to deliver selfless care that was often done in challenging conditions. However, pandemics are not a new aspect to this world, and nurses have played a central part in all of them only that maybe the mode of services and the context are different. How did they cope with this? What other struggles did they contend with? Did they have support systems in place? This paper will examine some of the challenges and encounters inpatient rural and urban nurses and NP’s experienced during the COVID-19 pandemic based on past experiences.
A Review of Nurse Role in Previous Pandemics
During previous pandemics, nurses’ experiences and actions are significant in informing current happenings, preparations, coping, and development of disaster policies and procedures. Pandemics burst into the world suddenly and spread faster into different regions where the hosts move. Nurses are always adamant about responding to various disasters in the community, such as hurricanes, earthquakes, accidents, and other infectious diseases. In history, there have been several cases of disease outbursts that bring several economies to a standstill. Some of the notable disease pandemics include the Spanish flu, H1N1 flu, polio, influenza virus, Ebola, MERS-CoV, and currently Covid-19. For comparison, we can use the 1918 influenza pandemic that had ravaged the United States, killing about 675,000 Americans and nearly 50 million people worldwide (Paterson et al., 2020). Both epidemics are a result of coronatine microbes that affect human beings. The Spanish flu and Covid-19 are similar in different aspects since they are airborne, transmitted from one person to another; they spread at higher rates and faster in cluster cases (Paterson et al., 2020). Covid-19 and influenza also have similar clinical manifestations such as cough, fever, dyspnea, sore throat, and muscle soreness, not considering their high mortality rates.
The origin of the 1918 influenza is thought to have originated from soldiers who fought the First World War, and that spread nearly to a third of the global population. The virus spread I the united states at a higher rate and was related to over 6500000 deaths. Influenza was associated with influenza type A also known as the ‘Spanish influenza.’ During that time, the nurses recall that the situation and notes that the population overcame the illness through organized nursing and medicine. The measures that nurses helped take included contagion control in different regions and reinforcing public hygiene (Paterson et al., 2020). People that would spit openly or sneeze in public were threatened with fines and arrest. Congregations such as churches were encouraged to ensure there is a free flow of air. Entertainment joints were shut down indefinitely, and in most offices, the staff was inspired to wear masks to work. Dorothy Deming, a student nurse at that time, recalls that the pandemic happened suddenly and spread like wildfire overwhelmed the hospitals, which were understaffed since some nurses were recruited to military work overseas (Paterson et al., 2020). Dorothy accounts that they were not prepared for the ordeal as emotional tensions rose when they noted that influenza did not only ravage the elderly and those with underlying conditions but also the youths in their prime life.
In 1918 there were no antibiotics, miracle drugs, oxygen therapy for patients, and nurses depended on the doctors who drafted long lists in which nurses had no idea at that time but eventually learned at work. The thing that matters most is that nursing stood the test of time as nurses performed their roles diligently without fear. Nurses were adamant in educating patients, families, and the public on the importance of maintaining respiratory hygiene, disinfecting household surfaces and utensils, and, most notably, having a mask (Paterson et al., 2020). Nurses provided care for the ill without fear. The downside of it all is that the epidemic did not spare some caregivers who were in contact with infected patients and also succumbed to the illness.
The 1918 influenza pandemic borrowed much from the teachings of a notable person on nursing, Florence Nightingale, who was born nearly a hundred years before (1820-1910). In fact, 2020 was declared by WHO the ‘year of the Nurse and Midwife’ in honor of the Florence Nightingale 200th birthday (Gallagher, 2020). The 1918 influenza pandemic capitalized on her hygiene teachings, which were proper sanitation, good hand washing, and implementing other sound preventive measures such as exposure to fresh air (Gallagher, 2020). Florence Nightingale played a crucial role in developing nursing as she served attended to the soldiers in the catastrophic Crimean war. She was sensitive enough to draft letters to the families of the soldiers that succumbed during the war and treatment, and in her draft, she was always careful to ensure that the soldier remained honored while their families knew of the ordeals (Gallagher, 2020). Such acts by nurses are replicated in the current Covid-19 situation, though not through the use of letters but more efficient means such as the use of phones and other technologies. Nightingale saw the importance of initiating nurse training programs to have enough staff catering for wellness programs and provide evidence-based and compassionate care.
It is also important to go way back in time to understand the aspect of care in a pandemic that struck Asia and Europe in the mid-1300s, known as the Black Death or bubonic plague. The plague is said to have originated from infected sailors who docked at the Sicilian port of Messina in 12 ships that had dead sailors, and those alive were seriously ill covered in black boils that oozed pus and blood (Cesana, Benedictow & Bianucci, 2017). Little did the people who went to see the ships know that they would be part of the 20 million people that were ravaged by the disease over the next five years from 1347 (Cesana, Benedictow & Bianucci, 2017). The plague attacked the lymphatic system as there were huge swellings in the groins and armpits and could also spread easily to the lungs and blood. The disease was spread through the air, contact, and bite from infected fleas and rats, which were common pests during that period all over Europe.
Role of Nurses and Nurse Practitioners in the COVID 19 Pandemic
There were no sophisticated techniques during the Black Death, and caregivers could only try to offer their help as they also did not understand the plague. They used boil-lancing, burning herbs, bloodletting, and other superstitious methods such as bathing clients in vinegar and rose water (Cesana, Benedictow & Bianucci, 2017). The epidemic affected the economy, and panic made the healthy people flee to avoid the sick only to find that they could not escape since even domestic animals were infected. Caregivers in that era even avoided seeing their patients for their safety. Over the years, leadership officials understood that they could curb the spread by isolating arriving sailors until they realized they did not have the illness. The stay was for 30 days (a Trentino), which was later increased to 40 days, commonly known as quarantine, originated from the port city of Ragusa. This practice continues to be practiced in every disease outbreak to date, but the number of days depends on the disease’s pathophysiology.
In reviewing the few epidemic incidences, we note common nursing themes shared between the various historical times despite the place and circumstances. The first role is the proactive responsiveness of nurses and other caregivers towards improving the patients’ and masses’ well-being. The various pandemics show the improvisation of different measures at local and national levels. The caregivers are cooperative and collaborate with stakeholders from different areas and, most importantly, show leadership and courage (Paterson et al., 2020). The incidences in pandemics and disasters can be heartbreaking even to the experienced clinical professions, but with the right team, they can persevere to continue helping in community support. Nurses help restore order in chaotic environments by focusing on cross-cultural, environmental, and professional strengths in response to disasters (Paterson et al., 2020). Another common theme is the way healthcare has borrowed from other past pandemics, especially with evidence-based approaches. For example, quarantine is seen to borrow from over 700 years ago and basic nursing concepts from Florence Nightingale. The best thing with sciences is that they appreciate documented records and experience to inform knowledge and skill in current situations. Some concepts from past pandemics are currently being applied or improved with the COVID-19 case.
How things have changed from a century ago
The current situation on how COVID-19 and recent disease outbursts have been handled is way more efficient than previous epidemics a century ago thanks to advancements in research, technology, education and healthcare, making the world a much safer place. However, modern developments are in specific ways acting as a risk factor to the development of other severe pandemics. For example, globalization, transportation, and urbanization have made it easier for people to quickly traverse the world in almost two days, which raises the risk of spreading pandemics at higher rates than before (Wu et al., 2017). Transportation even puts the people in the most remote areas prone to disease outbreaks. Urbanization has caused millions of people within a central region, helping bacteria and viruses to spread quickly through contact. The human population has also increased immensely over the past years leading to excessive use and need for resources. More health risks have been promoted through various human activities such as pollution. Human encroachment into different wildlife habitats such as oceans and wildlife increases the occurrence of zoonotic diseases. Multiple studies show that wild animals such as bats and rats, including domesticated species such as primates, account for the majority of zoonotic illnesses transferred from animals and spread to humans (Borsky et al., 2020). Other activities such as agriculture in wildlife, hunting, and wildlife trade puts humans at risk of encountering pathogens that significantly impact their health and well-being.COVID-19 was speculated to originate from Wuhan, China, from people that had consumed bats. There is high consumption and trade of wildlife species in China, such as bats, snakes, and such, which is considered illegal and unhealthy in some cultures and states.
Climate change is a severe aspect of the current world, affecting human beings’ interaction with their environment, and altering disease spread habits. For example, changes in humidity and temperature are spreading the reach of pests such as mosquitoes, which can spread different forms of pathogens, causing the spread of illnesses such as the zika virus, chikungunya, and malaria outbreaks (Brugueras et al., 2020). Another aspect that is hard to ignore is the growth and development of communication and social media. Despite the various benefits of social media to health care and well-being, it is also being used to spread misinformation and falsehoods, which can create panic and irresponsible behavior in a pandemic situation. For example, social media platforms are expanding with people and groups that are spreading an anti-vaccination narrative. In cases where the vaccinations are good for one’s health, then the young generations and the unvaccinated are placed in vulnerable situations. When misused, social media is a hazardous tool since information spread is instant all over the world, which may propagate other health problems
The changes from a century ago do not mean that everything has changed since some aspects remain constant, such as nurses’ role and epidemiological science practices (Paterson et al., 2020). The current determinants processes used to assess disease and health problems are still the same that was used in the 1918 influenza pandemic. Care processes aimed at solving health problems follow the same sequence, which includes collecting data, assessment, hypothesis testing, and action. Pandemic data is collected, and a hypothesis is formulated, which is then tested, and the results are used to inform knowledge and devise interventions. Through evidence-based practice, nursing roles in current healthcare systems have dramatically evolved to include informatics, leadership concepts, and other duties only conducted by physicians in the past.
Role of Nurses in Covid-19 pandemic based on prior epidemics.
Covid-19 pandemic has significantly altered different aspects of Nursing, such as the scope of practice, workflow, staffing, practice considerations, and physical resources, calling for great flexibility in the profession. The idea that most people have about nurses revolves around providing care. Still, in this epidemic, they have dome much more than that to include participating in research and advising the government, planning humanitarian responses to the pandemic and organizing public health teams (Schwerdtle et al., 2020). By numbers, nurses are the majority of all health workers in the health care system, and thus their impact is being felt in the current hard times. In the first place, nurses were brave to put their lives on the line to promote health and wellbeing in an unpredictable pandemic, continually develop, and behave differently to different population groups worldwide. For example, in the spring of 2020, there was uncertainty on the way things kept changing from acquisition of PPE to their effectiveness and quality in mitigating acquiring the viral infection (Owens, 2020). Such debates on supply chain issues and production developed mistrust, worried nurses, and their sense of safety as their health ought to be prioritized. Previous pandemics show that even caregivers were not spared when they came into contact with infected patients without proper safety measures. COVID-19 is highly contagious hence the need for nurses to take precautions and observe proper hygiene. Unfortunately, by September, the International Council of Nurses (ICN) announced that more than a thousand nurses are known to succumb due to COVID-19 (ICN, 2020). The situation is critical since disturbing reports show that nurses and other health workers in different countries are still neglected during the pandemic due to politics leaving them exposed to additional risks such as prejudice, violence, mental illness, and other infections (ICN, 2020). Considering the workload during the epidemic, some nurses are still underpaid, undervalued, and treated as expendable tools.
No industry has felt the pressure of COVID-19 than healthcare since the high rates of cases are overwhelming healthcare systems putting great demand on caregivers. Some care institutions were forced to alter work agreements with other staff to cut costs that would be channeled towards care provision and servicing the problem of inadequate staff (Paterson et al., 2020). Throughout history, all pandemics show that nurses are scarce, which calls for their dedication to multitask and work for long hours. Some institutions considered recruiting more volunteers, including ongoing students and retired nurses, but what was prevalent, as advocated by Florence Nightingale, was staff training to ensure they were competent in different clinical areas. Some of the salient roles that nurses have played include:
From the onset of the pandemic, nurses were in charge of processing, assessing, and caring for patients efficiently and quickly out of their skills and experience. A patient that tested positive was moved rapidly to quarantine and put under necessary care. The current advancements in research supported by nurses’ data made it quicker to stream line care and discover various interventions that were effective to some patients, for example, oxygen therapy, a practice that was not there ages ago (Stirling, Hatcher & Harmston, 2017). Nurses are maintaining an inventory of medical supplies, protective gear, and medical equipment to avoid cases where they could become scarce with an increase in patient admission and ensure appropriate use. The cases of PPE use were serious since they became scarce in some institutions, and nurses could use a single mask for a very long period, which placed them at risk of contracting the virus instead of a single mask when seeing each patient.
Flexibility to adapt to new settings
COVID-19 made it impossible for patients who ought to be seeking medical care to resist visiting clinics due to fear of the disease and restrictions to stay home. Care institutions had to capitalize on technology and other means of care delivery to ensure other patients had access to care. Nurses had to sacrifice more while experiencing fear of the unknown to avoid their friends and family and had to sleep in secluded hotels in isolation. Their mode of care had to evolve since there were institutions such as prisons, nursing homes, and the homeless with COVID-19 cases, and they had to be on the move to provide care (Jackson et al., 2020). Nurses had to adapt to longer shifts and risk burnout to care for more patients and cover for nurses who fell ill, creating a workforce shortage.
Advocating for patients and family
One change that was made during the current pandemic is on restricting family presence by the bedside as a measure of curbing the spread. Studies support family members’ presence as it provides the patient with the hope of quick recovery, reduced stay in hospitals, and providing a sense of protection and care, which reduced patient anxiety. Lack of family puts a lot of pressure on the patient to keep on fighting, and the nurses have to play a part as a family proxy to help in moral and emotional support (Owens, 2020). Some COVID-19 patients were more vulnerable and had underlying conditions, which changed the nurse roles; they were aware some of the patients were at the end of life and had no relatives within the vicinity. Some situations were super sad, especially where nurses held patients’ hands while placing a computer screen in front of them to say goodbye to their families. After such moments, nurses could only get comfort from their colleagues whom they could interact with some social distance level since even a simple hug is dangerous. The experienced nurses who had been through different epidemics helped console and mentor the inexperienced nurses, but, all in all, they have to remain strong. Some nurses, especially at the reception, faced hard times restricting visitors and family members from leaving their patients and heading back home; some even encountered threats.
Disease prevention and health promotion.
Nurses were adamant in COVID-19 awareness, management, and education thanks to the advancements in technology, unlike with previous epidemics a century ago. Nurses recorded videos on the importance of people remaining at home, maintaining social distance, maintaining hygienic practices, and wearing masks. Some recorded their distressing working conditions to ensure people understand the pandemic’s seriousness and the strain it is causing on the health sector. Teaching and communication was a constant thing since people looked up to nurses for guidance. There was a lot of misinformation, conspiracy, and trust issues of which nurses cleared by answering and demonstrating some practices such as washing hands for kids while providing resources for reference, including a hotline for suspected cases and guidance from the ministry of health website. Nurses capitalized on informatics and mobile technology to record every detail of their patients, which made it easier for contact tracing and follow ups. This matter was difficult with previous pandemics. Documentation also helped in understanding the pathophysiology of the disease and inform various research.
Lessons and Recommendations.
The previous pandemics and the current COVID-19 outburst offer different lessons for nurses and nurse leaders in developing a solid plan that can help quickly identify, manage, and treat contagious illnesses. Evidence-based practices that are effective in different aspects are recorded for reference in the future. COVID-19 has greatly put the healthcare sector to test, more so on nurses’ ability to learn, think critically, adapt, and play a part as champions of health and change. Pandemics show the importance of maintaining clear communication and solidarity with colleagues, communities, and nations in the globalized world (Schwerdtle et al., 2020). Pandemics act as an opportunity to redefine nursing practice, especially aspects that seem not to work. As part of maintaining proper self-care and community health, nurses have an obligation to enroll in continuous training that help redefine their role and increase their competence which helps them overcome fear, anxiety , and powerlessness (Owens, 2020). There is also the need for government institutions and hospital management to reevaluate their supply chains, especially with the aspect of quantity and quality of personal protective equipment and prioritizing nurses and caregivers’ wellbeing at large.
In conclusion, we note that nurses play a significant part in healthcare more than ever before, being the pillars of health services, maintaining ground at the forefront of every pandemic, providing considerate care, and providing education and advice to legislators on health policies and public health (Schwerdtle et al., 2020). COVID-19 is yet to end, but some countries have health workers that have managed to lower the spread to numbers that have caused the reopening of the economy, but more worrying figures show that there is likely to be a second wave of the pandemic, creating more uncertainty (Jackson et al., 2020). The great aspect with improved outcomes during epidemics shows that if people adhere to evidence-based advice and practices, future disease outbreaks can be simpler to handle and with fewer consequences (Gallagher, 2020). Standard protocols can be developed to deal with infectious diseases and the implementation of policies, procedures, and curb mass hysteria.
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