Moving Forward: Lessons Learned From the COVID-19 Pandemic : Dimensions of Critical Care Nursing

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DEPARTMENTS: Guest Editorial

Moving Forward: Lessons Learned From the COVID-19 Pandemic

O'Donoghue, Sharon C. DNP, RN; Hardman, Jacqueline BSN, RN; DeSanto-Madeya, Susan PhD, RN, FAAN

Author Information
Dimensions of Critical Care Nursing: 11/12 2021 - Volume 40 - Issue 6 - p 309-310
doi: 10.1097/DCC.0000000000000497
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Since the COVID-19 pandemic began, greater than 600 000 individuals have lost their lives in the United States alone.1 Hospitalizations requiring an intensive care unit (ICU) stay have skyrocketed causing an extreme strain on our health care system.2 Providing care to a large influx of critically ill patients has been a daunting task requiring constant change and flexibility to best meet their needs. Sharing the important lessons learned and ensuring patient and staff safety will be paramount in improving the delivery of health care and in our ability to care for our current health care providers.

Many lessons were realized during this unprecedented pandemic. The principles of crisis standards of care helped organizations best augment care with limited space, staff, and resources.3 Although all these elements are paramount, ensuring staff were redeployed to suitable areas with appropriate education was essential. While having space and resources is obviously a necessity, without essential health care providers, namely, nurses, respiratory therapists, intensivists, and pharmacists, there is no delivery of care.

Intensive care units across the country needed more ICU and medical-surgical nurses to assist in caring for the unparalleled number of patients. Being able to quickly identify those nurses who had previous ICU experience was important to start the redeployment process. After the first surge, our hospital developed a disaster preparedness assessment tool that identifies competencies a nurse possesses no matter the job title. During our second surge, this assessment tool provided us with vital information about the ability of staff to assist in meeting our surge needs. An assessment tool provides hospitals with a better understanding of the competencies their current staff possess in the case of another catastrophe.

In the wake of a pandemic, redeployed staff are provided with “just-in-time” training. This training should focus on safe practices, basic concepts in critical care, closed-loop communication, and roles and responsibilities.4,5 Training should be 4 hours or less to not overload staff and ensure completion; additional resources should be provided such as handouts to augment content learned, disaster documentation standards, and nursing care of the patient specific to the pandemic.6 In this issue of Dimensions of Critical Care Nursing, our team has shared our experience around providing a shadowing experience to the redeployed staff member.7 This was extremely helpful in allaying their fears, reducing anxiety, and preparing them for their new role. The shadowing experience was between 4 and 12 hours in length where the redeployed staff member spent one-on-one time with an ICU nurse. Some redeployed staff felt comfortable returning to the ICU and only needed a quick refresher. Others wanted a longer time to review the knowledge learned in the didactic portion of their just-in-time training.

While ensuring the appropriate staff are educated for redeployment, identifying the ideal space and equipment is necessary. In 2012, our ICUs collaborated with our emergency management system in a drill and built a fully functional ICU on a general medical-surgical ward to evaluate our abilities in a disaster.8 Our goal was to assess the current plans we had on paper to evaluate their functionality and ensure we were prepared for a “real-life” disaster. All hospitals should have specific plans to clearly identify the processes—where and when to expand as well as those items required to ensure safe delivery of health care. A hospital incident command center is a must to help facilitate this work and manage all incoming needs.9

Managing the needs of these critically ill patients required many thoughtful approaches. Problems were identified quickly, and appropriate leaders came together to respond to mitigate these concerns.10 Proning and central-line teams were developed and deployed to meet the large numbers of ICU patients who needed these interventions.11-13 It was integral to have specialized teams with specialized skills to ensure patient safety and support for the already overburdened staff. Quality improvement initiatives were bountiful and highly successful.

The emergence of the COVID-19 pandemic brought uncertainty and stress as leadership and staff responded to a multitude of challenges. In our effort to respond to the first surge, health care providers focused on how to deliver optimal care with the current staffing ratios and limited resources. At the same time, it was also essential to develop new ways to keep ourselves and our families safe. It was difficult to reflect on our own worries because there was little time to care for oneself. No one had any idea what the surge would look like and what was to come. This caused anxiety and uncertainty, which lingered after the first surge was wavering. Providing emotional support was complex because there were so many unknowns and an overwhelming fear of a second surge. Although the stress was heightened during this unprecedented pandemic, we realize that there must be systems in place to support health care providers in their everyday work, every day.

When the first surge was over, it was difficult to decide when to go back to “normal.” Could the expanded ICUs really be closed? Could equipment be put back in storage? Could we restart education and teaching sessions to move our “normal” ICU work forward? The looming uncertainty was and continues to be anxiety producing. What does our future hold? Are we facing another surge at some point? Or will it be a trickle of patients, and will it be manageable? We continue to live in an uncertain time. These questions continue to inform and motivate us to be prepared. We are sustained by success in many areas and have many lessons learned to move us forward.

Although the pandemic was an unprecedented occurrence, it has prepared us for potential future catastrophes. COVID-19 required the collaboration of multidisciplinary teams to ensure optimal outcomes in an overextended environment. Staff rose to the challenge by working extended hours, being redeployed to other units, and placing their own safety at risk. Many positive lessons were learned from this difficult experience. We must continue to be vigilant in our assessment of what worked and did not work and look for ways to improve our health care delivery systems.14 The memories from this past year and a half cannot be forgotten, and we can move forward confidently knowing we provided the best care possible despite all the hardships.

References

1. Center for Disease Control and Prevention. COVID Data Tracker: United States COVID-19 Cases, Deaths, and Laboratory Testing (NAATs) by State, Territory, and Jurisdiction. Washington, DC: US Department of Health & Human Services. https://covid.cdc.gov/covid-data-tracker/#cases_casesper100k. Updated July 29, 2021. Accessed July 30, 2021.
2. Center for Disease Control and Prevention. COVID Data Tracker: COVID-19 Hospitalizations and Disease Severity. Washington, DC: US Department of Health & Human Services. https://covid.cdc.gov/covid-data-tracker/#hospitalizations-severity. Updated July 29, 2021. Accessed July 30, 2021.
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5. Matos R, Chung K. DoD COVID-19 practice management guide: clinical management of COVID-19.; 2020. https://apps.dtic.mil/sti/pdfs/AD1097348.pdf. Accessed July 30, 2021.
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7. O'Donoghue SC, Donovan B, Anderson J, et al. Doubling ICU capacity by surging onto med surg units during the COVID-19 pandemic. Dimens Crit Care Nurs. 2021;40(6).
8. Public Health Emergency. Emergency Management and the Incident Command System. Washington, DC: US Department of Health and Human Services; 2012. https://www.phe.gov/Preparedness/planning/mscc/handbook/chapter1/Pages/emergencymanagement.aspx#1.3.2. Accessed July 30, 2021.
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11. Nawathe P, Wong R, Pollock G, et al. Creation of a dedicated line team for critically ill patients with COVID-19: a multidisciplinary approach to maximize resource utilization during the COVID-19 pandemic. J Vasc Access. Published online February 4, 2021; 1129729821991754. doi:10.1177/1129729821991754.
12. O'Donoghue SC, Church M, Russell K, et al. Development, implementation and impact of a proning team during the COVID-19 surge. Dimens Crit Care Nurs. 2021;40(6).
13. Barbash IJ, Kahn JM. Fostering hospital resilience—lessons from COVID-19. JAMA. Published online July 29, 2021. doi:10.1001/jama.2021.12484.
14. Mintie Tech. BIDMC emergency drill: operation contagion [Video]. YouTube. https://www.youtube.com/watch?v=jFiv1hx-HJc. Accessed July 30, 2021.
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