The tailored meticulous nursing management dealing with COVID-19

April 2nd, 2020 in Hot Topics, International News

Sharing the experience of Huanggang City, China

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.

  1. 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.

Figure 1. The establishment of the temporary isolation ward in Hong ‘an County

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 patient satisfaction

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 guidance.

Figure 2. The morning shifts in Dabie Mountain medical center

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.