Author: Huifen Wang, Yining He, Xiaocheng Huang, Yongyi Chen, Bo Xu Institutions: Hubei Cancer Hospital, Oncology Nursing Committee of Chinese Nursing Association
In order to deal with the outbreak of pandemic of COVID-19 in Wuhan, China has established 16 mobile cabin hospitals to treat patients infected by COVID-19 with mild symptoms. Mobile cabin hospital is a kind of modular health equipment, which has many functions such as emergency rescue, surgical treatment, and clinical test. With good mobility, rapid deployment, strong environmental adaptability, it could undertake many emergency medical rescue missions. The establishment of a mobile cabin hospital can effectively relieve the pressure of the shortage with the medical resource in Wuhan and will become a veritable cabin of life. Since the outbreak of the epidemic, nurses at Hubei Cancer Hospital have actively applied for front-line services, and a total of 100 outstanding nurses have been selected to fight the epidemic, providing care for patients with COVID-19. The innovative nursing management in a mobile cabin hospital is distinctive from that in other general hospitals.
Setting up of the mobile cabin hospital Three medical teams from Hubei Cancer Hospital took over three mobile cabin hospitals. The 1200 beds in Wuchang mobile cabin hospital are divided into three parts including Area A, B, and C. Hubei Cancer Hospital was responsible for the construction of A1 area which was comprised of 120 beds, 20 doctors and 40 nurses. Nurses undertook treatment, care, psychological support, health education, infection control, meal ordering, food delivery and distribution of living materials in this ward unit. They also were responsible for the management of Hongshan mobile cabin hospital containing 120 beds, 17 doctors, and 31 nurses. The team has been responsible for it for 60 days. Finally, 364 mild patients have recovered successfully under meticulous care. They also have established the party school mobile cabin hospital and were in charge of the F1 area with 65 beds, 20 doctors and 30 nurses, and 93 mild patients.
Preparations of the mobile cabin hospitals within 48 hours There were two days for preparatory works of the mobile cabin hospital. Before the admission of patients, they might furnish medical area and living area with all kinds of cabinets, camp beds (not beds), bedside tables, treatment vehicles, blood pressure monitors, blood oxygen monitors, infusion racks, medicines, disinfection facilities, bedding, and toiletries for patients, etc. They tried their best to place the ward units to meet a criterion of hospital standards. They reasonably divided the whole place into several functional areas like clean area, potential pollution area, contaminated area, medical staff channel, patient channel, etc, and posted corresponding signs in each area. In order to better meet the clinical need, they formulated the workflow to guide clinical nursing work, including how to receive, treat, nurse, check and take medicine.
The environment and medical supplies management of the cabin We accepted patients and inputted their information into internet. After they settled in their beds, we do some assessments, take temperatures, take oxygen saturations, draw blood and gather pharyngeal swab, do health education, bed unit sorting and so on. They also distributed meals, masks, fruit, milk, towels, clothing, etc. for daily use to patients. At the cabin hospital, they were responsible not only for the care of the patients but also for the management of the cabin and the daily life of the patients.
Humanized shift arrangement At the beginning of the shift, nurses worked in the cabin for 6 hours. If we include the time of wearing and taking off the protective clothing, handing over and other works, it was approximately about 9 hours of working time. After a long time of working with PPEs, the nurses might suffer from chest tightness, nausea and vomiting, hypoglycemia, dizziness, as well as other discomfort symptoms. Some nurses often missed meals in the cabin, they could not get enough energy they need.”It can’t be going on like this.” According to the actual situation, several investigations were arranged among nurses and managers. Considering some of the nurses might feel uncomfortable after a long period working in the cabin, the working time was adjusted accordingly. The 4-hour shift system was finally determined. Four-hour shifts, six shifts a day, four to six people per shift, one or two more people for throat swabs or blood collection. A group leader was responsible for the management of rescue beds in the ward unit, and a senior nurse was arranged as rescue nurse. Each group also has one nurse in charge of a fire evacuation. In addition, each shift will have a mobile nurse. They would take the place in case there be a situation of someone sick or things like that.
Psychosocial support The patients admitted to a mobile cabin hospital were those who’s virus detection result was positive for COVID-19 with no severe symptoms. Due to the unfamiliar environment and simple living conditions, many of them will feel anxious, suspicious, fear, hopeless, and isolation. Nurses would do a psychological assessment and deliver psychological support to the patients. Psychological counsellors would be appointed to offer them a face-to-face conversation to release their pressure. Also, volunteers would be available to connect with their family members and increase their social support. Additionally, kinds of activities to relieve physical and mental pressure was arranged for them. A temporary library was set up to provide a variety of books also.
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:
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
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.
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.
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.
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.
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.
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.
Authors: Xuying Li, Yongyi Chen, Bo Xu, Boyong Shen Institutions: Hunan Cancer Hospital, Oncology Nursing Committee of Chinese Nursing Association
During the global pandemic of COVID-19, the nursing managers from Hunan Province of China were appointed to Huanggang City of Hubei Province. Under the wholehearted support of nursing team from the hospital, they have established a custom-made meticulous nursing management system, 47 emergency plans & procedures, and an innovative nursing model based on the epidemic situation of Huanggang. With their counterpart aid, the epidemic prevention work of hospitals in five counties of Huanggang has made a significant achievement. No Infection has occurred in health care workers; more than 600 patients in severe condition have discharged from the hospitals uneventfully. This meticulous nursing management system has strongly enhanced the quality of patients’ care and ensured the occupational safety, which worth promoting and spreading.
Set up temporary “anti-epidemic” wards to bridge gaps in diagnosis and treatment
The Hunan medical team was allocated to rebuild four isolation wards and a new intensive care unit in Dabie Mountain medical center, as well as establish isolation wards in the other 4 counties of Huanggang including Hong ‘an, Luotian, Macheng and Yingshan. Boyong Shen, one of the members of Hunan medical team, was mainly responsible for design of the ward layout, the establishment of nursing systems, processes and standards for the ward. She carried out homogenized and standardized management according to the 9S standard of fine nursing management of “SEIRI, SEITON, SEISO, SETKETSU, SHITSUKE, SAVE, SERVICE, SAFETY, SATISFACTION”. Totally, eight isolation wards and one ICU were built up with the concerted efforts. The nursing expert team supervised all the medical staff to strictly obey the hospital infection prevention and control, try ways and means to enhance the work efficiency, and ensure the safety and security of patients and health care workers to the most extent.
2. Develop various systems to guarantee the quality of care
Firstly, the nursing expert team formulated standardized job description for every position and shift to make sure that every worker fully understands and consciously follow their duties, work objectives, work content, and work requirements. Secondly, they made requirements for nursing documentation of COVID-19 to offer rule-based regulations for nurses, avoid the randomness of work.
3. Formulate workflow to guide clinical nursing work
In order to better meet the
clinical need, the practical and operable document: The Prevention and Control Workflow Version 2.0 for nurses dealing with
COVID-19 were developed by the team. 47 commonly used clinical nursing and
hospital infection control procedures were included to provide advice for
clinical nurses. Meanwhile, Training was strengthened to constantly improve the
professional level and competencies coping with COVID-19 of nurses.
4. Humanized shift arrangement to ensure the
dynamic of nurses
Group scheduling was deployed in the isolation
area which reasonably divided nurses into different groups according to the
work experience and background. Experienced head nurses or nurse backbone
served as group leaders who were in charge of the group. The primary nurses
were responsible for patients’ care. They collaborated on 6-8 patients
respectively. Additionally, professional ICU nurse specialists led nursing team
members to provide better care to patients in severe conditions and reduce the workload
of nurses. Finally, to further specify the division of responsibilities and
support nurses entering into the isolation area, five shifts including the
information shift, general affairs shift, infection control shift, treatment
shift, and coordination shift were set up in the clean area.
5. Enhance training to improve capacity of nurses facing COVID-19
On one hand, pre-job training were
carried out to all nurses including the proper use of personal
protective equipment (PPE), intensive
care, first aid skills, contingency plan, etc. Only the ones who passed the
pre-job examination could be deployed to the post. On the other hand, special
training was organized in the morning shift meeting. The principal
contents included the post
responsibilities, work processes and standards, intensive training of key
skills, and quality assurance. Updated content according to corresponding
requirements (e.g., renew knowledge to the prevention and control of COVID-19
and the regulations). Secondly, internet based learning was used to promote
mutual discussion, work briefing, and problem feedback and rectification.
6. Conduct nursing rounds to improve the patient care
Firstly, adopt multidiscipline nursing rounds comprised of medical and
nursing team members, to further identify patient’s conditions
and treatment plan for the next stage. Secondly, head nurses were required to be
familiar with the condition and nursing process of all patients, as well as
carry out nursing rounds for patients with severe and complicated conditions. Thirdly, focus on the problems of
patients, nursing experts analyzed carefully, figured out a detailed care plan,
and tracked the implementation and effect of nursing measures.
7. Implement humanistic care to improve
Use social media to strengthen doctor-patient
communications. Wechat groups were determined for online consultations, mutual
support, and psychological decompression. The online interactions helped
increase the social support. Under huge pressure, some patients might endure
mental disorders, nurses paid attention to their psychological status and
observed their emotions, words and deeds, mentality and other abnormal
situations. Nurses would chat with patients about the daily life in every
nursing interval, listen to them, and introduce successfully cured examples to strengthen
their confidence. To enhance the continuity of care, nurses would connect
with communities when discharging to strengthen post-discharge rehabilitation
8. Set up evaluation system to guarantee the
safety of patients and health professionals
In order to assure
the safety of medical staff, professionals in charge of hospital infection were
arranged to assist and guide the occupational protection of medical staff.
Before entering the isolation wards, special personnel were assigned in clean
area for 24 hours to ensure the correct wear on/take off of PPE according to
the checklist. A series of nursing quality assurance forms were developed for
scientific assessment and continuous quality improvement. On-site supervisions
were supplied by the nursing expert team every day to guide strict
implementation in accordance with the standards and procedures. Head nurses of
isolation wards carried out “five
inspections a day” to improve standardized nursing care and patients’ satisfaction.
On behalf of the ISNCC Board of Directors, it is with great regret that we announce that the International Conference on Cancer Nursing (ICCN 2020) will be postponed until early March 2021.
This decision was taken after close monitoring of the rising global risk assessment by the World Health Organization of the COVID19 outbreak. Although the risk of transmission of the COVID-19 Virus is currently assessed as moderate in the United Kingdom and enthusiasm for ICCN 2020 has remained high, the global situation is changing every day in unpredictable ways.
We recognize the need to care for the health and welfare of our participants and of the host community. We are cognizant of the travel restrictions that are being extended on a daily basis and impacting our colleagues’ ability to attend ICCN 2020 and we want to express our support for our colleagues who are in the frontlines of caring for their patients. We also are aware that health institutions, organisations and education facilities are restricting employees and students travel and participation in upcoming conferences.
ICCN2020 is proceeding as planned, and a great program is in place. ISNCC is aware of the global news regarding the Coronavirus (COVID) and the evolving travel advisories. At the moment, health authorities in the United Kingdom stated that risks to individuals in the UK remain low (https://www.gov.uk/guidance/wuhan-novel-coronavirus-information-for-the-public). We’re following the guidance of the World Health Organization (WHO) and the UK Department of Health and Social Care. We will monitor the UK Foreign Office (https://www.gov.uk/foreign-travel-advice/china and communicate any changes for arrivals in the UK. Please note that many airports have added additional screening for visitors arriving from China and for those who have visited China recently.
As nurses we know, and the WHO reminds us, frequent hand washing with soap and water is the best way to prevent infections.