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Departments: The Founders' Column

COVID-19 Pandemic Challenges and Lessons Learned

Making Meaning and Preparing for Future Pandemics

Editor(s): Gregory, Katherine PhD, RN, FAAN, Neonatal Editor

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The Journal of Perinatal & Neonatal Nursing: April/June 2022 - Volume 36 - Issue 2 - p 103-105
doi: 10.1097/JPN.0000000000000656
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The Founders Column serves the purpose of providing a historical perspective on perinatal and neonatal nursing. Diane Angelini, cofounder and long-standing perinatal editor of The Journal of Perinatal & Neonatal Nursing (JPNN), wrote the inaugural column in our 36.1 issue. In this column, she shared her perspective on what was involved in launching JPNN more than 35 years ago and the substantive content of the journal over nearly 4 decades. Diane highlighted that over time, as a journal grows and matures, and as the state of the science in nursing care advances, the breadth and depth of manuscript quality improves. I think we can all agree that JPNN has become an important source of knowledge that helps guide the clinical practice of thousands of perinatal and neonatal nurses around the world.

I could not have anticipated that I would be writing this edition of the Founders Column as we prepare to navigate the third year of the COVID-19 pandemic. Many are looking for a signal that will allow us to declare an end to the pandemic. However, the more we learn about the SARS-CoV-2 virus, the more we come to acknowledge that declaring a formal end to the pandemic is unlikely. Rather, we must learn to live through what can only be characterized as the COVID-19 pandemic era. As nurses, this era has been an extraordinary time of difficult challenges and many lessons learned. I have 2 aims in acknowledging some of the many challenges and reflecting on some of the many lessons learned from the pandemic. First, I hope that some of my observations will help current perinatal and neonatal nurses make meaning of their experiences during this time in history, and second, I hope that future perinatal and neonatal nurses can learn from our experiences, preparing them for future pandemics.

CHALLENGES OF THE COVID-19 PANDEMIC

The SARS-CoV-2 pathogen was first reported from China in December 2019. The disease caused by this virus was termed COVID-19 by the Centers for Disease Control in January 2020. The immediate impact on overall nursing care and clinical operations was felt most in the United States in early “hot spots” (ie, Seattle, New York, and Boston) and then reverberated across the nation throughout 2020 and 2021 as the virus and variants surged. Some of the greatest challenges to nursing care and clinical operations during these surges were related to availability of personal protective equipment, SARS-CoV-2 testing, the acuity and number of COVID-19 patients, lack of knowledge on how to effectively treat the disease, and wellness among the healthcare workforce. The pandemic required clinical staff to be redeployed from one clinical setting to another, many of which were unfamiliar to individual members of the team. The culmination of the stress and anxiety during the first year of the pandemic contributed to the departure of hundreds of clinicians, notably nurses, from the healthcare workforce during the second year of the pandemic.

Perinatal and neonatal nurses experienced all of the clinical challenges that have been common across the COVID-19 pandemic (ie, limited access to personal protective equipment, testing, high patient acuity and volume, healthcare worker stress, fatigue, and burnout). In addition, there have been unique challenges associated with caring for patients during pregnancy, labor, and birth, the postpartum and neonatal periods. These challenges included but were not limited to

  • - limited social and emotional support during labor, birth, and postpartum and neonatal care as a result of restrictions in the presence of support persons and visitors;
  • - less intensive breastfeeding education and support; and
  • - isolation throughout the postpartum and neonatal periods.

To decrease the overall number of people in the hospital and meet the need for physical distancing and infection prevention, the number of support people and visitors allowed in the care environment was significantly limited. For many patients, this was a major disappointment in their care, and in some cases, notably during labor and birth where the presence of additional labor support persons is an evidenced-based approach, this pandemic-induced challenge was a contributor to suboptimal care outcomes. In the newborn intensive care unit, there were times during the pandemic when some hospitals needed to restrict family presence to one person at the bedside at a time. This made patient- and family-centered care, a cornerstone of our practice, difficult, if not impossible. While virtual means were used in many settings to help bring families together, nurses learned quickly that this was a poor substitute for having families physically present with one another. Overall, the inability to provide optimal social and emotional support to patients and their families as a result of the pandemic became a source of moral distress for perinatal and neonatal nurses.

During the pandemic, many postpartum patients requested early discharge from the hospital. This was especially common in “hot spots” during COVID-19 surges, when patients were fearful of being in the hospital and wanted to return home quickly to prevent the possibility of contracting infectious disease. One of the major consequences of early postpartum discharge is a lack of breastfeeding education during hospitalization. In addition, many hospitals stopped offering group breastfeeding classes, further limiting access to breastfeeding education and support. As a result, many patients received suboptimal breastfeeding care, with an impact on overall breastfeeding rates. Seeing these outcomes was troubling for nurses and especially upsetting for lactation consultants.

Finally, one of the most significant challenges associated with the pandemic era for perinatal and neonatal nursing practice was the isolation that patients experienced—both during hospitalization and upon hospital discharge. This often resulted from the need for physical distancing, preventing spread of infection, and an abundance of caution, given limited knowledge of the long-term effect of the SARS-Co-V-2 virus during pregnancy and among newborns. Nurses have long known that social and emotional support is critical during the adjustment that follows labor and birth, and welcoming a new baby to a family. Seeing patients so isolated during this vulnerable time of their lives was difficult and sometimes could not be overcome.

LESSONS LEARNED FROM THE COVID-19 PANDEMIC

The challenges associated with the COVID-19 pandemic have led to many lessons learned among perinatal and neonatal nurses. A few of these lessons learned include the following:

  • - Virtual care is an important aspect of nursing care, but it does not meet all of the social and emotional support needs of perinatal and neonatal patients.
  • - We can make clinical practice changes more quickly than we thought, but we must continue to assess the evidence underpinning these changes and adjust our approach to care when needed.
  • - Supporting nurses throughout a pandemic, with a particular focus on stress reduction and burnout prevention, must be a critical component in planning for a pandemic.

The pandemic era has brought forth unprecedented use of virtual technologies to deliver care to patients and families. In many settings, this has been an effective way to deliver and improve access to care. It has also been a novel approach to care in some areas of perinatal and neonatal nursing. A good example of this has been use of virtual care to provide access to breastfeeding education and support. Many women who would have had no breastfeeding education and support during the postpartum period were able to access this care during the pandemic as a result of virtual lactation consultation. This proved to be an effective use of virtual care and for some women, a preferable approach to lactation consultation. Another example of virtual care that was needed during the pandemic, but found to be less effective, was virtual visitation during hospitalization. Many hospitals implemented virtual visitation as a strategy to connect patients and families when they could not be physically present with one another. While this did help families communicate with one another and the healthcare team, it was not the same as having family members and support persons physically present with patients during their care. An important lesson learned from the pandemic is that virtual care, while an important aspect of care, does not meet all of the social and emotional support needs of patients and families.

Making clinical practice changes in nursing care is often a complex and time-intensive process. However, during the pandemic, hospitals and healthcare organizations experienced rapid and unprecedented change in multiple areas of care. The pace at which change was made during the pandemic created stress and anxiety for many nurses. While this was challenging, the experience of making rapid change during the pandemic taught us that we can make changes in clinical care to meet a need more quickly that we ever imagined. This was an important lesson learned. An even more important lesson learned was the need to constantly evaluate these changes based on new and emerging evidence relevant to the clinical practice. These are 2 important aspects of our practice that I hope we carry forward from the pandemic era.

We have long known that nursing is a demanding profession—physically, mentally, and emotionally. One of the most important lessons learned from the pandemic is the need to prioritize social and emotional support for nurses, especially during the extenuating circumstances that occur during a pandemic. While many hospitals struggled to successfully accomplish this goal, some found success in supporting nurses with mindfulness meditation, messages, and actions of appreciation and gratitude, and perhaps most important, consistent communication about the state of the pandemic and the challenges that the organization and its healthcare workforce are navigating in a coordinated manner.

MAKING MEANING OF THE CURRENT PANDEMIC FOR FUTURE PANDEMICS

The COVID-19 pandemic has been one of the most significant historical events in our lives as nurses, with far-reaching and unprecedented impact. Making meaning of this global event requires us to reflect on all of the challenges we have navigated and the many lessons we have learned about how to take care of patients and families, especially in the perinatal and neonatal care areas. I think for many, the culmination of the lessons learned goes back to the basic fundamentals of nursing care: to use the most scientifically rigorous evidence available to provide high-quality nursing care that is patient- and family-centered, ensuring that the care provided results not only in optimal physical health but also in social and emotional health outcomes. Keeping these fundamentals as the highest priorities, along with lessons learned related to how we use virtual care, make change, communicate with one another, and support our nursing workforce, will help guide nurses through future pandemics.

—Katherine Gregory, PhD, RN, FAAN
Neonatal Editor

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