29.10.2020 | Kommentarer

Nurses balancing duty to care for patients amidst fear of contracting the Covid-19 virus

Abstract 

This article highlights the challenges faced by nurses while attempting to balance their duty under professional ethics to care for the patients of COVID-19 amid the horrifying fears of contracting the virus. Although this is true for most nurses around the globe especially, incountries where the virus has hit hard, this article only points to some examples of experiences by nurses from countries like Kenya, Finland, China, and the USA. The information herein is
intended for the healthcare administrators and organizers to enable them to understand nurses’ plights, to support them. It also challenges them to come up with ways to minimise the hardships facing the medical personnel. This article is also intended for the citizenry of the stated countries and the general public since it serves to create awareness, and it tries to bring to light what nurses go through in their course of duty. As a result, the aim is to make the general public aware of the impact this pandemic has on the health care providers, in the hope that once the public is aware, they might cooperate in adhering to the prevention and precautionary measures given by the World Health Organization and their respective governments. It is hoped that taking these
measures will help in avoiding a resurgence of Covid-19 infection numbers, hence suppressing the burden and challenges faced by the nurses who may then have the necessary equipment and personnel to take care of other ailments.

Authors: Yli-Panula, Elizabeth BSc nursing student, Novia UAS and Wikberg, Anita supervisor, RN, RM, PhD, Senior lecturer, Novia UAS.

Introduction

COVID-19 disease is caused by the SARS-CoV-2 virus. This epidemic has had devastating impacts on the global economies and the populations around the world. The initial outbreak of the virus was first reported in Wuhan China in December 2019 hence the name Covid-19 (Chen, Lai, and Tsay, 2020). The virus is said to cause a sudden respiratory infection. Symptoms may include pyrexia (fever), cough, sore throat, dyspnea (difficulty breathing), muscle aches, and headache. Also, other symptoms have been reported to include a loss of taste, loss of smell, and diarrhea. After the outbreak, governments around the world were put on high alert as the disease continued to spread like a bushfire causing panic and with-it death and suffering to the masses. The unexpected outbreak exerted pressure on the fragile health care systems and its workers around the world (WHO, 2020a). Quoting words from the poem, “The Second Coming” by William Butler Yeats, things seemed to fall apart, and the center could not hold; as mere anarchy seemed to have been loosed upon the world (Butler, 1989). As workers in the frontline fighting this pandemic, nurses continue to play a key role in the public health response to the crises, as they deliver patient care to the infected persons. They, therefore, find themselves caught up in a conflict between their duty to care for the infected patients and the risk of exposure, which might put them at risk of contracting and likely dying from this highly infectious disease (Fernandez, 2020).

The new Coronavirus is like the SARS coronavirus (International Council of Nurses’, 2019). Experts compare its highly infectious nature and the ability to kill masses to the Spanish flu that scientists say killed over 500 million people between the years 1918 to 1920 (World Health Organization (WHO, 2020b). As of the 24th of October 2020, more than 42 million people were confirmed to have been infected with the virus and more than 1 million people have since died worldwide. In Finland alone, COVID-19 has infected more than 14474 people and has caused more than 350 deaths (The Finnish Institute for Health and Welfare, 2020). As of 24th of 0ctober 2020, Kenya had reported 47,843 coronavirus cases and 884 deaths, while China reported 85,755 cases with 4,634 deaths (Worldometer, 2020).

The fears connected with COVID-19

It is difficult to predict when the COVID-19 pandemic will come to an end, and all hopes are that soon there will be a discovery of a vaccine capable of fighting the virus. The bottom line is that it is unpredictably precarious, and people are left to live in phobia and worry every day about the physical and mental health safety of their families, friends, and themselves (The Finnish Institute for Health and Welfare, 2020c). It makes it worse that COVID-19 is highly contagious, and it will bring a high death toll on health care workers if immediate interventions are not taken (WHO, 2020a).
The fear that the nurses have revolved around safety. Most nurses have expressed concern for a lack of adequate Personal Protective Equipment (PPE) when caring for patients with or suspected of having COVID-19. According to a study published in BioMed Central to explore the perceived infection routes for healthcare workers, the results showed that most nurses are infected when attending to patients. The lack of enough protective equipment resulted in the nurses recycling e.g. the N95 masks potentially risking exposure to infected patients and contaminated fluids and aerosols. (Kabale & Mutanu, 2020). The World Health Organisation (WHO) 2020, has insisted on the importance of every country to properly equip nurses who were putting their lives at risk, especially in times of crisis.
According to The International Council of Nurses (ICN) 2019, many nurses are infected with COVID-19 and others have died, many countries do not have exact numbers since they are not collecting that data. This puts nurses and patients at risk during the fight against COVID-19. According to a New York post, during the initial outbreak of the virus, there was so much unknown as to the transmissibility of the virus and some nurses in China were reported to be shaving their heads to reduce the risk of cross-contamination. The nurses tried every way to reduce the pathogens from spreading and argued that being bald also made it easier to put on and take off protective suits (New York Post, 2020). In Kenya, like other developing countries, nurses and victims of COVID-19 face enormous challenges since most of them rely on public transport to and from work putting the general population at a greater risk of contracting the virus. The nurses also face stigmatization by the general public as they are considered major disease spreaders. Also, most health care workers face uncertainty about medical insurance coverage in an event that they contract the disease (Amoth, 2020).

According to the Kenyan Ministry of Health, about 838 healthcare professionals have contracted coronavirus while at work. Guidelines by the Health Ministry require healthcare workers to wear full protective equipment while working with COVID-19 patients, however, there is a scarcity of PPE and there are cases of reported poor quality PPE (Amoth, 2020). Another factor that could have led to the high cases of nurses contracting the virus as per the secretary-general of Kenya union of clinical officers George Gibore, is the fact that most health workers had no previous training on how to handle Covid-19 patients and how to protect themselves (Wanjohi, 2020).

Li Wenliang, a Chinese doctor according to an article published by BBC News in February 2020, succumbed to COVID-19 while treating patients in Wuhan only after he warned the world about the impending coronavirus outbreak. His death sparked public anger and grief in China and the rest of the world. In Finland, in April 2020, the Finnish National Institute for Health and Welfare reported 43 more deaths due to coronavirus, and health workers were included in the death toll too (The Finnish Institute for Health and Welfare, 2020c). An article published by foreigner.fi. news reported by Yle.fi in April 2020 stated that Finland's coronavirus fatalities were likely under-reported. This could lead to fewer supplies by the government to handle the real statistics of fatalities and even new cases. This burden is eventually transferred to the nurses and this is likely to cause fear and panic among the health care providers.

Stabilizing care with the fear of COVID-19 and work ethics

Nurses are continuously involved in assessing, intervening, and monitoring patients at various levels of health facilities. Although nurses choose the profession as a calling to alleviate the suffering of individuals, they are required to abide by a professional code of ethics to ensure that each patient receives individualized optimum holistic care characterized by compassion, regardless of their condition (Kennedy, 2019). However, nurses must work in an environment in which they feel safe and confident (Buheji & Buhaid, 2020).

Overcoming fear associated with COVID-19 when providing care to patients requires that the nurses undergo specific training related to the pandemic response. Healthcare facilities should also ensure that there is constant availability of quality PPEs and strict adherence to all guidelines as provided by the WHO. Following this protocol provides a safety net to the nurses’ failure to which some may opt not to work in the COVID-19 isolation units. This would then result in an aggravate shortage of healthcare providers. Professional codes should provide guidelines on the obligations of the nurse to their safety, while in the duty to care for patients with highly infectious diseases during pandemics (Ruderman et al, 2006).

In Kenya, there have been fears raised by the communities regarding how the individuals succumbing to COVID-19 are treated. While the burial procedures set by the Kenyan Ministry of Health and WHO are necessary to prevent the spread of COVID-19, they are implemented in a manner that is perceived by the communities as disrespectful to the deceased and the bereaved families. For instance, an article published by Wasonga and Okeyo in the Kenya Daily Nation newspaper in April 2020, highlighted concerns of disrespectful handling of the corpse of a person who died from COVID-19. In this case, the bereaved family is not allowed to perform their final rites before the body is buried. These burial procedures raised fear among the nurses in the unlikely event that they contracted the virus or worse passed it on to a member of their family resulting in death.

There is also the ethical code of nurses to their patients which has also raised a lot of concern. This is especially due to a shortage in the supply of ventilators. There have been reported cases where nurses are faced with a tough decision to take ventilators from some patients to accommodate other patients. For instance, if there are 10 people in the emergency room waiting to get a ventilator, others will have to get off the ventilator for others to use it based on an evaluation of the medical situation of the patient. There have been unconfirmed reported cases where this scarce commodity has been limited to only patients with a better chance of survival. If a patient is found not to respond well to the treatment, and it does not look like using this scarce resource is a wise investment, then, another patient who might have a better chance of survival is accorded the device. Nurses sometimes have to choose if to leave their patients first and save the lives of those of close family and relatives (Ruderman et al, 2006). An article by Christopher Cheney on March 2020, on health leaders, stated that in China there were reports of care rationing as the supply of resources such as ventilators were outrun by the number of hospitalized COVID-19 patients. China, the initial epicenter of the pandemic, had the highest reported cases of COVID-19 at more than 80,800 as of March, according to the world meter.

According to The Finnish Institute for Health and Welfare, 2020b, in Finland, the first case of coronavirus otherwise called case zero was confirmed at the end of January 2020 and was attributed to a middle-aged Chinese female tourist who is said to have left Wuhan China in early January 2020 and arrived in Rovaniemi, Finland. She was said to have later sought medical attention in Ivalo after falling ill and tested positive for SARS-CoV-2. A few days later, her first symptoms developed to a runny nose and a persistent fever. Persons in close contact with the patient were traced. There were 21 individuals, 17 of whom were reached. After a while, more cases were reported as the infections started to rise drastically probably from other tourists who might have visited the country around the same time.

Nurses experience with COVID-19

Most nurses have reported feeling overwhelmed both physically and emotionally, by the increased workload and a change in shift patterns that was necessitated by working long hours. For instance, an article published by Alice Suchina correspondent, in February 2020, through Los Angeles Times wrote that some doctors and nurses fighting coronavirus in China died of both infection and fatigue. According to the New York Post, some nurses had to work long shifts while in diapers due to demand for the continuous care of incoming new critical patients of COVID-19, who required very close monitoring. This was also necessitated by a shortage of personal protective equipment, and the need to reduce the time it took the nurses to undress and redress when going to breaks or when using the restrooms.

When sharing their experiences, nurses also pointed out the level of unpreparedness for the emergency pandemic response, which forced many nurse managers to hurriedly adopt to come up with isolation centers to accommodate the expected surge of Covid-19 patients. The Nursing staff also expressed concern that they were not well prepared and trained in handling emergency pandemics, especially of a new disease little studied and known to the experts.
It is of paramount importance that the lessons and experiences learned during this pandemic be integrated into future nurse training courses to prepare future nurses physically and psychologically on what to expect and how to deal with pandemics in case of future disease outbreaks.

Conclusion

Nursing is a caring science characterised by compassion and commitment (Coffey et al, 2019). The highly contagious nature of COVID-19 threatens the nurses’ ability to do their duty of care while in an environment that puts their health at risk. The experiences during this pandemic indicate the need to amend the current nursing codes of ethics, policies in health care systems, and nursing education to respond to future pandemics. Despite offering their services, nurses have dynamic reactions to the COVID-19 pandemic. Nurses’ fear of contracting the virus could be overcome through having safe working environments and clear policies on their safety. The nurses’ duty to care is delivered in the context of a healthcare delivery system with varying factors, environments, and cultures. The unsafe environment of care, the condition of the patient, and the safety of the nurse present a challenge to the nurses’ duty to care. To overcome challenges that may inhibit the nurses’ performance of duty, there is a need for professional bodies to work together with nursing policy-makers and educators to identify the approach and processes that will support nurses (Choi et al, 2020). Without this support, nurses are likely to experience significant stress, anxiety, and physical side-effects, which can lead to burnout and loss of nurses from the workforce (Fernadez, 2020). Further effort is necessary to develop strategic recommendations and to integrate new knowledge into nurses’ education. The immediate efforts to control and prevent COVID-19 and to care for those who are infected remain a concern (Chen at al, 2020).

According to The Finnish Institute for Health and Welfare, 2020a, every citizen can slow down the spread of the coronavirus by their actions. In everyday life, infections can be prevented by taking care of hand hygiene and avoiding close contact with other people. The coronavirus (SARS-CoV-2) is transmitted as a droplet infection when an infected person coughs or sneezes. In close contact, the virus can also be transmitted through contact if, for example, the patient has coughed in his hands and has since touched another person. Florence Nightingale is one of the nurses and the pioneers who worked with epidemics through the principles of hygiene and sanitation. Nightingale showed the connection between infection control and hand washing (Buheji & Buhaid 2020). Nurses play a key role in providing public education on Covid-19 prevention and reducing the spread of misinformation around the outbreak (Choi, 2020). There is misinformation on how COVID‐19 is transmitted, in some cases, Chinese and Asian people are assumed to be at higher risk for being infected with COVID‐19 because of their nationality or their race, leading in stigma and xenophobia (Choi et al, 2020).

Nurses on the frontline and behind the scenes need to be encouraged. Hopefully, a vaccine will be out soon as there is a lot of research work and studies being conducted to come up with a vaccine. In the event that a vaccine is not developed soon, then we can only hope that by following the advice by experts like social distancing, hand-washing, and masking that soon we will be able to fight the virus. It is also hoped that countries and the health care systems have learned from this pandemic and will better prepare in case of future pandemics.

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