Nursing experience for severely ill patients with Covid-19

May 5th, 2020 in International News

Jiangxi counterpart support Suizhou anti-epidemic nursing experience sharing

Authors: Jinhua Hong , Dan Luo
Institutions: Jiangxi Cancer Hospital, Jiangxi Hospital of Traditional Chinese Medicine and Western Medicine

At the beginning of 2020, after the outbreak of Covid-19 in China, according to the unified deployment of the National Health Commission, Jiangxi Province has sent three batches of 389 medical team members to help Suizhou City, Hubei Province.25 cases of severely ill patients and 50 cases of critically ill patients have been managed in Suizhou Central Hospital. The nursing experience is now reported as follows:

  1. Higher nursing manpower requirements.
    Because it takes time to put on and take off protective clothing, and, it is inconvenient to move with protective clothing, goggles, and three-layer gloves, the nursing staff consumes a lot of energy, requiring higher manpower. In the Covid-19 Severe Ward, the number of nursing staff is configured according to the bed-to-care ratio of 1: 6, and each shift is 4 hours to ensure that the nursing work is carried out in an orderly manner. Through our selection, all intensive care personnel have been trained in intensive care and have intensive care experience
  2. Characteristic schedule with collocation of nursing staff in Jiangxi and Suizhou.
    Due to different cultures, different ward environments, and different dialects, we use characteristic schedule method. Nurses from Jiangxi are mainly responsible for patients; the local nurses in Suizhou are responsible for office work and coordinate with external. Each shift must have at least one local nurse.
  3. Closely observe the changes.
    The condition of critically ill patients change rapidly, the patient condition should be observed at least every half an hour. Focus on monitoring body temperature, breathing rhythm, frequency and depth, and blood oxygen saturation. Accurately record the amount of 24 hours in and out, observe the vomit and stool frequency, nature and amount. Nursing staff should fully understand the patient’s condition, be familiar with the results of various tests performed by the patient to provide information and evidence for treatment and care. For patients with high fever, it is better to use traditional Chinese medicine acupressure coordinated with physical cooling.
  4. Oxygen inhalation.
    Severe patients can be given oxygen by a high-flow nasal cannula or mask according to the situation. Patients receiving oxygen by nasal catheter should wear surgical masks.
  5. Strengthen respiratory management.
    Strengthen the patients turning over, back kowtows, and suction, follow the doctor’s advice to cooperate with prone position to improve lung ventilation and promote sputum excretion. Patients using non-invasive ventilator should adjust the parameters of inspiratory pressure, expiratory pressure and oxygen concentration according to the doctor’s orders. For patients who need to establish an artificial airway by tracheal intubation or tracheotomy, the nurses need to adopt closed-type sputum suction and perform artificial airway management under the implementation of three-level protection measures.
  6. Keep patients comfortable and dignified.
    Strengthen communication with patients, produce dialect-specific cards; implement patient skincare, oral care, etc. Pay attention to patient privacy, and keep patients clean, comfortable, and dignified.
  7. Provide emotional support and humane care.
    Considering patients with Covid-19 are quarantined from their loved ones for a long time, they are in lack of family and social support, often show anxiety and fear. Nursing staff should accurately assess the patient’s psychological state and needs, provide appropriate emotional support and humane care, help patients to contact with their families by telephone, WeChat or video, and give support and encouragement. At the same time comfort the patient’s family.
Figure 1. Patients with anxiety and difficulty breathing in the Covid-19 ICU ward of Longmen District of Suizhou Central Hospital. Psychological counselling was conducted by Hong Jinhua to guide patients to adjust their breathing and relax.
Figure 2. In the Covid-19 ward of Wendi District of Suizhou Central Hospital, Luo Dan performed closed suction for the patient and observed the color, nature, and volume of the sputum.