January 2021- More than 96 million people have tested positive for Covid-19, and near two million deaths have occurred worldwide. Of the total number of cases, the United States ranks high (25%) in community transmission and in the number of deaths (19%) when compared to countries worldwide.
In the United States, more than 24 million people have or have had the virus, and more than 400,000 lives have been lost [1,2]. Covid-19 transmission and death rates continue to go up on a daily basis in higher numbers than reported in the first three to six months of the pandemic [2].
The Covid-19 pandemic has affected many. Men, women and children of all ages have spent more time at home than anywhere else. Parents in the workforce are working at home and juggling all – kids at home, zooming in to meetings, becoming home teachers, and more – all rising up to the challenges in this new unprecedented world.
Unemployment has sky-rocked; service industries in particular have had to close their doors or reduce capacity; and, financial assistance is very much needed by those who have lost their jobs and no longer have a steady income, while yet having the burden of every day expenses.
The pandemic has affected men and women of all ages, and nurses and all healthcare workers caring for those in hospitals, long term care facilities, in the community or in other settings. First responders, primary care offices, public health agencies and health care systems continue to be challenged in responding to the needs of men and women and children of all ages, in ensuring safe environments and needed care delivery.
The person needing care has navigated services, many times alone and without family. The pandemic has had its effects on routine lifestyle and health behavior of many, as all have had to adjust and develop new patterns of everyday behavior – to know and understand the social, nursing, and medical impact of all is important.
COVID-19 Workforce
At least fifteen hundred nurses have died worldwide from Covid-19, although statistics are not available in all countries worldwide. Nurses, physicians, and healthcare workers continue to provide an unprecedented level of healthcare- selflessly and with willingness and commitment to those affected by the virus – in hospitals, ICU’s, ER’s, nursing homes, and other facilities. Selflessly, nurses and others have quarantined and isolated themselves from family when at home after a long day or days away, so as to keep their own families safe and healthy.
Since the pandemic began, personal stories among health workers include working with inadequate amount of medical supplies and personal protective equipment (PPE). Distress regarding concerns of safety, and obligations and duty for care continue among nurses and others as equipment and PPE resources to protect oneself continue among nurses [3,4].
Care needs among COVID-19 hospitalized patients in some states already exceed the availability of ventilators and number of healthcare staff, discussions of today include exploring priorities for care - who will get care if we can not provide for all? [5]
Nurses and team members continue to step up to provide care by working limitless hours and less days off to meet continuing demands for care. Stress, depression, anxiety, insomnia and suicide is increased among nurses and physicians [6], as concerns and fears are present regarding the potential self-transmission of COVID to family members, community transmission, as risk is increased.
Nursing leadership is called on and continues to step in in recognizing the importance of providing social and organizational support, to help nursing staff on the front lines to increase personal resilience and reduce COVID-19 related anxiety [7].
Healthcare management
Impact of community transmission of COVID-19 is demonstrated on many levels – including varied age groups, personal health status, socioeconomic status, and known social determinants that can influence community transmission. Those who live in all communities, who are socioeconomically disadvantaged, have healthcare challenges, or who may feel more isolated because of cautious and limited social opportunities are all affected.
The chronically ill and those who require elective surgery may have stayed away from healthcare – both by choice as well as limited availability of health care services in hospitals, primary care offices, and other places. Telehealth has more widely been implemented as an important method of monitoring, care providing care and follow up of needed services. For those who have come to the hospital, family members are absent as Emergency Rooms and Intensive Care settings fill up with men and women of all ages in ongoing distress or on ventilators. When men and women die related to complications of Covid-19, each dies alone without family, as risk of transmission can be reduced and controlled.
To know and better understand how Covid-19 has affected the process and outcomes of care among varied age groups, socioeconomic conditions, the living and the dying, or those who are healthy or who have chronic disease is important.
Call to Action
Many have called nurses the ‘heros’ or ‘warriors’ who are essential to the healthcare system and care today. Television programs and the media have honored and further explained our story of the sacrifices and the unending care by nurses everywhere. Nursing research is already underway in schools of nursing and in clinical settings. In spite of professional stress in nursing and clinical environments, - students continue to come up the ranks, to be supported by nursing faculty who have rapidly responded to promote the best of on-line learning and who continue to nurture and attend to the needs of students everywhere.
A Covid-19 – focused research agenda can include the study of all. As the need for safe distance, handwashing and facial covering and other guidelines continue, some choose to adhere and others do not. Although the vaccine is now available with high degrees of known efficacy, already not everyone feels comfortable in receiving the vaccine – understanding reasons as to decision-making concerning available health choices is important.
In the everyday experience of healthcare and nursing leaders, educators or clinicians, there are many questions to be answered, as nurses contribute to the advancement of nursing science in understanding of COVID-19 and its effects. Knowledge-building in nursing and healthcare, both in the laboratory and in the process of care and outcome measurement is important.
As this pandemic continues, Nursing continues to capture the moment as best as it can – through dedicated leadership, clinical care, education and research. As difficult as it is, let all who are doing their best day in and day out in caring for self and others continue to feel professional pride in meeting ongoing challenges in clinical care, education and in research.
References:
1. World Health Organization. 2021. WHO Coronavirus Disease (COVID-19) Dashboard . Retrieved at https://covid19.who.int/
2. Johns Hopkins University and Medicine 2021. Covid Resource Center. CCovid-19 Dashboard by the Center for Systems Science and Engineering (CSSE) Retrieved at thttps://coronavirus.jhu.edu/map.html
3. Shechter A, Diaz F, Moise N, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020;66:1-8. doi:10.1016/j.genhosppsych.2020.06.007. Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297159/pdf/main.pdf
4. Fernandez R, Lord H, Halcomb E, et al. Implications for COVID-19: A systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic. Int J Nurs Stud. 2020;111:103637. doi:10.1016/j.ijnurstu.2020.103637. Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206441/pdf/main.pdf
5. Achkar, MA. 2020. Deciding who lives and who dies. Modern healthcare. Retrieved at https://www.modernhealthcare.com/opinion-editorial/deciding-who-lives-and-who-dies
6. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun. 2020 Aug;88:901-907. doi: 10.1016/j.bbi.2020.05.026. Epub 2020 May 8. Erratum in: Brain Behav Immun. 2020 Dec 9;: PMID: 32437915; PMCID: PMC7206431. Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206431/pdf/main.pdf
7. Dimino K, Horan KM, Stephenson C. Leading Our Frontline HEROES Through Times of Crisis With a Sense of Hope, Efficacy, Resilience, and Optimism. Nurse Lead. 2020;18(6):592-596. doi:10.1016/j.mnl.2020.05.011. Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529385/pdf/main.pdf