Author: Donata Oyuga, BSc nursing student, Novia UAS
Supervisor: Anita Wikberg, RN, RM, PhD, Senior lecturer, Novia UAS

Abstract

Nurses have been at the forefront of battling COVID-19 pandemic worldwide. Their life has been at a stake especially at the initial stages of the pandemic, when there were no vaccines to protect them from being infected. The nurses were infected because COVID-19 is transmitted from one person to another by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

SARS-CoV-2 is a communicable virus and it is the cause of COVID-19. The disease was discovered in Wuhan, China and it rapidly spread to other countries hence, the outbreak was then regarded to be a pandemic. Nurses have played different roles during the pandemic.  On the other hand, they have faced different challenges some of which have interfered with their mental state. Despite the challenges they have been facing, they have still soldiered on to perform their duties to ensure that they make a difference in people’s life. However, nurses need support from the organization to help solve some of the challenges that they are experiencing. During the pandemic, nurses have adhered to the preventive measures put in place and received the vaccination to prevent them from being infected. Also, the public has followed the WHO guidelines and the restrictions placed by the government and they have been receiving the vaccination to prevent them from being infected. Nurses have worked extremely hard during the pandemic and with no benefit of a doubt, they are true superheroes.

Introduction

Globally nurses are considered to be the backbone of the healthcare sector (Jackson et al., 2020, p. 3). This has even become more evident during the COVID-19 pandemic because nurses have been at the frontline battling the pandemic. In the early stages of the pandemic, they encountered negative emotional responses. They were very stressed, worried and anxious. They feared that they did not have control over the pandemic and the knowledge and skills that they had were not sufficient to enable them to deal with the pandemic. Nurses did not have previous knowledge about COVID-19 as there were no reliable sources, but over time they acquired knowledge about the disease (Demirci et al., 2021, pp. 739–740). Nurses were also concerned about their health and that of their families. Although they were fearful about the pandemic, they continued to deliver care and some of them were infected with COVID-19 and had to be isolated. Nurses lacked sufficient personal protective equipment, they lacked enough support from the organizations and the organizations lacked adequate staff. However, as time went by the working conditions became better (Ardebili et al., 2021, p. 553; Buheji, 2020, p. 19; Moradi et al., 2021, p. 7). Despite the experiences that nurses have had, they are satisfied with the positive impact they have made on people's lives, nursing being valued in the community and the support they have received (Demirci et al., 2021, p. 740).  

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of coronavirus disease 2019 (COVID-19). SARS-CoV-2 is a positive sense one stranded zootonic RNA virus, which is communicable in people (Del Rio & Malani, 2020, p. 1039; WHO, 2021a). Coronavirus disease 2019 is transmitted when an infected individual coughs or sneezes and uninfected individual comes into contact with the droplets. The common symptoms of COVID-19 are fever, dry cough and fatigue. The severe symptoms are difficulty to breathe, pain in the chest or inability to speak or move. When a person is infected with the virus the symptoms can appear within five to six days although in some cases it can appear within fourteen days. People with mild symptoms can stay home and monitor their condition while those with severe symptoms should go to the hospital, so that they can receive treatment and care from the health care personnel. The elderly and individuals with chronic illnesses such as heart diseases, chronic respiratory disease and cancer are at a high risk of being infected with COVID-19 (WHO, 2021b).

This infectious disease began in December 2019 in Wuhan, China (WHO, 2021a). In the beginning majority of COVID-19 cases were found in China and people, who had travelled to China (WHO, 2021c). In Finland, the first COVID-19 case was discovered in Lapland in a Chinese tourist on January 29^th, 2020. On February 13th, 2020, COVID-19 was encompassed as part of dangerous communicable diseases. COVID-19 started to spread rapidly in Finland at beginning of March due to the travels to the Alps for holidays (Tiirinki et al., 2020, p. 649). On 11^th March 2020, WHO declared that COVID-19 outbreak was a pandemic (WHO, 2021d). Currently in Finland, the total number of corona cases as of 1^st September 2021is 134,827 and the number of deaths is 1051 (Finnish Institute for Health and Welfare, 2021).

The role of nurses during COVID-19 pandemic

Nurses need to continuously educate patients and the public about COVID-19 (Choi et al., 2020, p. 1486). The nurse can do this by informing the public and patients on the reliable sources that provide reliable information regarding the COVID-19.  Such as, WHO and Centers for Disease Control and Prevention to avoid inaccurate information that some may have and this helps to promote evidence-based infection prevention (CDC, 2021; WHO, 2021b). Although, in the initial stages of COVID-19 pandemic there was no clear information to assist in dealing with the situation (Moradi et al., 2021, p. 7). Therefore, there is a need for nurses to be educated about infectious diseases such as COVID-19 as soon as there is an outbreak (Buheji, 2020, p. 19)

Patients experience various symptoms of COVID-19 that can change from time to time and this makes them afraid of the situation. This is because they have to be quarantined and stay away from their families, and also their livelihood is affected. Nurses offer support and reassurance to the patients when they are experiencing various stages of COVID-19. The nurses keep the patients relaxed and relieve their uncertainty, they ensure that the patients do not receive inaccurate information about COVID-19, and also nurses ensure that patients are not over informed about the hazards of COVID-19 (Buheji, 2020, p. 14).

Nurses have been at the forefront during the COVID-19 pandemic and have taken care of the patients when they are admitted to the hospital and they offer intensive critical care (Buheji, 2020, p. 13). At the peak of COVID-19, there was an increase of patients that required ventilators to help them in breathing and the Intensive Care Unit could not accommodate all these patients. Therefore, the general wards were transformed into ICU wards and more doctors and nurses were trained on critical care medicine and deployed in regions that were greatly affected (Hopman et al., 2020, p. 1549).

Nurses provide patient centred care to all infected patients and indulge in preparation for the high number of nursing and health system that is needed in relation to COVID-19 (Choi et al., 2020, p. 1486). Nurses are among the health care personnel administering  COVID-19 vaccines to the public (Finnish Government, 2021a). Nonetheless, nurses have experienced several challenges during the COVID-19 pandemic (Goh et al., 2020, p. 646).

Challenges faced by nurses during COVID-19 pandemic

Globally nurses have battled with the effect of COVID-19. Nurses did not have personal protective equipment, diagnostic tests, which affect the clients' safety and health practice. Nurses had not been trained and did not have knowledge about COVID-19 and there was a shortage of nurses to take care of the increasing number of patients and some of the nurses, who were asymptomatic had to be in quarantine at home for fourteen days. This made the situation of shortage of nurses worse. When they were on duty, they were afraid that they might be infected with COVID-19 and infect their family. Due to this, they have developed mental issues for instance depression and anxiety, which makes them consider quitting their job (Buheji, 2020, p. 14; Góes et al., 2020, pp. 7–8; Moradi et al., 2021, p. 7).

In Finland, the forefront health care personnel, who were most affected were nurses. Nurses were adversely affected, since they had to take care of COVID-19 patients and they had direct contact with their patients. They experienced different challenges that affected their wellbeing  and they therefore, need support to improve their wellbeing (Haravuori et al., 2020, p. 7911). According to Finnish law, during a pandemic operations in a ward can be changed inorder to accommodate other patients. For instance, during COVID-19 pandemic some of the wards could be converted to COVID-19 patients ward. Nurses in Finland were obliged to work during the pandemic, some were moved to different wards and they had to perform different duties. Their working time and holiday were interfered incase there was a need for them to report on duty. Also, in the evident that the COVID-19 cases could have been overwhelming for the workforce that the health care sector had by then. Then all health care personnel including nurses aged 18 years to 67 years could have been expected to step in to help fight the pandemic (Finlex, 2021; Finnish Government, 2021b).

ICU nurses did not receive sufficient support from the organization. The nurses were overloaded with work as there were fewer nurses to take care of the patients in the ICU. They lacked enough personal protective equipment and they faced discrimination in receiving the personal protective equipment, since doctors were given priority. The nurses also became fatigued due to the long working hours, wearing the personal protective equipment and they did not have rest days. In the early stages of the COVID-19 pandemic nurses lived with uncertainty because there was no clear information on how to deal with COVID-19. There were also no vaccines or medicines that have been proven to effectively prevent or treat COVID-19. Nevertheless, nurses had a teamwork spirit to deal with the demanding conditions (Babore et al., 2020, p. 4; Buheji, 2020, p. 19; Moradi et al., 2021, p. 7).

Nurses working in long term care facilities were more emotionally affected because they have built relationships with their patients, who stay in the facilities for a long duration. So the nurses became empathetic and emotional to see their patients being quarantined, sick and passing away. Nurses experienced burnout as they were physically, mentally and emotionally affected because of the numerous numbers of COVID-19 patients, whose health conditions would worsen and they had to learn new ways of taking care of the patients and processes (Buheji, 2020, p. 19; White et al., 2021, p. 202). Upon all these nurses felt that they were not appreciated for the work that they did (Góes et al., 2020, p. 8). However, it is vital to prevent oneself from being infected by COVID-19. The nurses and other healthcare personnel as well as the public, should follow the restrictions and recommendations placed by the government and organizations. This will help control or eradicate the COVID-19 pandemic (Millar, 2020, p. 6; WHO, 2021b).

Preventive measures for nurses and the public during COVID-19 pandemic

To avoid being infected nurses are expected to attend to patients wearing full personal protective equipment, which includes footwear, face shield and when taking them off they should do it meticulously and safely, so that they are not in contact with outside surfaces that were exposed to the patient. Nurses should ensure that infected patients are isolated in negative pressure treatment rooms or single rooms. In the hospital, nurses should ensure that when they are transporting COVID-19 patients within the hospital, the COVID-19 patients are prevented from accessing public areas as much as possible and procedures ought to be carried out in a room. When transporting a patient from one floor to another, the elevator should only be occupied by the COVID-19 patient (Millar, 2020, p. 6).

For the public, the preventions to COVID-19 are applying hand hygiene, keeping one meter distance from others, not touching the face, covering mouth and nose when coughing or sneezing, staying at home when one feels ill, one should cease smoking and activities that damage the lungs, social distancing and to avoid travelling when it is not necessary (WHO, 2021b). In nursing homes and long term care settings, visitors were not allowed to visit the patients to help prevent the transmission of the infection to the elderly (Wang et al., 2020, p. 1190).

On March 16^th, 2020, the Finnish Government implemented lockdown with social distancing restrictions to reduce COVID-19 infection and keep individuals with underlying medical conditions safe. This has enabled Finland to have few cases of COVID-19 in comparison to other countries. Also, the pandemic was experienced late in Finland this made it possible for the government to execute restrictions and recommendations early enough and people have adhered to them (Tiirinki et al., 2020, p. 649).

A decree came from the Finnish government on how the vaccinations should be provided once the vaccines arrive in the country. The government listed the vaccine priority groups. The first group of people to receive the vaccines were healthcare and social welfare workers, who were in direct contact with COVID patients, those who provided emergency care and those working in long term care facilities. However, nurses working in ordinary wards were not prioritized and they did not receive the vaccine when it was given to people in the first group. The second group were 70 years old and above. The third group were people with underlying health problems and the fourth group were people, who do not fall in the first, second or third group. As of 17^th September 2021, 73.1% of the population have received the first dose and 53.0% of the population have received the second dose of the vaccine in their respective municipalities' health care facilities. The vaccinations are administered by health care personnel including nurses, who have the required vaccination training (Finnish Government, 2021a; Finnish Institute for Health and Welfare, 2021).

Conclusion

During a pandemic, nurses need to focus on taking care of the infected patients. There is a need of having organizational protocols and nurses require education on standard precautions for them to strive at delivering safe care. Constant education and information about the disease are vital, since it enables nurses to deal with COVID-19, educate and inform the public about the disease. (Buheji, 2020, p. 19; Góes et al., 2020, p. 7).

In a pandemic such as COVID-19, it does not take only the health care personnel to control or eradicate the infection, but also the organization as well as the government need to play a role to control or eradicate COVID-19. There is a need for health care facilities to finance the needed infection control measures and educate health care personnel on how to manage the infection and keep a safe work place (Millar, 2020, p. 5). Organizations need to invest in improving nurses' knowledge and skills that will not only be of use now, but also will be beneficial for future outbreaks (Purba, 2020, p. 28). The government and healthcare systems can help reduce the physical and mental distress that nurses experience. Nurses and other health care personnel can receive support when there is sufficient personal protective equipment, sufficient staff, adjusting the nurses' work schedule, recompense staff and listen to their worries, giving precise and evidence-based data and performing mental interventions, so that they can deal with the present disaster. When nurses receive support, it helps promote client care and safety (Moradi et al., 2021, p. 9).

When organizations provide resources to the nurses, it promotes the health and safety of the nurses, which leads to safe performance and provision of quality care to the patients (Cho et al., 2021, p. 175). The organization needs to appreciate and support nurses throughout the COVID-19 epidemic to promote their physical and mental health (Góes et al., 2020, p. 7). There is a need for the organization to take care of the wellbeing, occupational health and safety of nurses. Nurses have participated in dealing with COVID-19 and if they are provided sufficient support, it will aid in the eradication of the pandemic (Choi et al., 2020, pp. 1486–1487).

Notably, nurses have played a big role and worked tirelessly during the pandemic. Society has witnessed their value and appreciated the work nurses have been doing, since the pandemic began. Society has referred to nurses as superheroes in different social media platforms. The pandemic has made people realize the true value of nurses in the healthcare sector and to human beings (Williams, 2020, p. 2469). 

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