The nursing management practice in mobile cabin hospital, Wuhan China

May 6th, 2020 in ICNN Articles

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
Figure 1. The establishment of Wuchang mobile cabin hospital
Figure 2. The nurses were drawing blood
Figure 3. The nurses were making ward rounds with doctors