Management experience of care workers during epidemic prevention and control of COVlD‑19

Na CHENG, Run‑Xi TIAN, Nan TONG, Qing GONG,Jia‑Yue LI, Bao‑Jing WU, De‑Yu KONG

Second Department of Endocrinology of Nephropathy,Dongzhimen Hospital, Beijing University of Chinese Medicine,Beijing, China

ABSTRACT

Since the rapid spread of COVID‑19, our hospital has actively implemented the idea of “preventing the coronavirus from entering.” We paid close attention to details, rapidly carried out personnel and material management at all levels, and strived to do a good job in the prevention and control of the epidemic, so as to achieve zero infection. Patients’ carers are an important part of quality care. Lacking of protection knowledge of infectious diseases would increase the risk of nosocomial infection. Therefore, our nursing department set up a team of epidemic prevention and control management. The team made the revision on contingency plans and care management regulations during the outbreak of COVID‑19,strengthened epidemic prevention and control knowledge training, carried out the supervision inspection work, and paid attention to humanized management measures to provide an important guarantee for victory over the COVID‑19.

Keywords: COVID‑19, management, patient care

Since mid-December 2019, COVID-19 cases have been found in Wuhan, Hubei province. The epidemic spread rapidly with wide infection scope. Therefore, provinces and cities launched major public health emergency response plans. The confirmed cases with coronavirus are the main source of infection, followed by asymptomatic carriers. The population is generally susceptible.[1]As an indispensable group in hospital, care workers need to complete the basic nursing work of patients under the guidance of medical staff,including contacting patients at close range to help patients change their position and assisting patients in activities,eating, and so on,[2,3]so they are faced with a greater risk of cross-infection. Their mastery of the knowledge of infectious disease prevention has a great impact on the prevention and control of the occurrence and spread of infectious diseases in hospitals. However, there are generally with low education level and less awareness of infectious disease prevention knowledge among nursing workers.[4-6]Therefore, it is of great significance to strengthen the management training of care workers in hospitals to ensure the safety of both patients and care workers, thus preventing the spread of the pandemic.

STRENGTHENING NURSING MANAGEMENT AND IMPROVING THE EPIDEMIC PREVENTION SYSTEM PLAN

When the hospital encounters serious epidemic situation,it deals with the problem quickly and effectively to prevent the input of external cases, which concerns the safety of the hospital patients and all staff and even social stability. In the case of the epidemic situation, our hospital managers quickly analyzed the potential problems and made a positive response in time.

First, under the unified command of the hospital’s leading epidemic prevention and control group, the nursing department and the third-party company set up an epidemic prevention and control management group for care workers, which consisted of a management supervision group, a human resources coordination and emergency response group, and a training and publicity group. The nursing department was in-charge of organization, coordination, supervision, feedback,and auxiliary management in the epidemic. It timely adjusted the focus of epidemic prevention and control work according to the specific situation and set up the WeChat group of “epidemic prevention and control guard management” so as to conduct comprehensive supervision on the guard work at any time.

Second, it is of vital importance to revise and adjust emergency plan timely. COVID-19 was organized by the Ministry of Nursing. Through analysis of the original plan according to the epidemic characteristics, the specific contents of preventing and treating COVID-19 were supplemented. Moreover, it is necessary to establish the basic principle of “prevention first, unified command,level-by-level responsibility”, carry out full coverage investigation among the nursing staff in the hospital,establish a detailed registration form of personnel investigation, and update dynamically. We promoted the implementation of the treatment process for fever among nurses during the epidemic and organized emergency drills for epidemic events. In addition, the most crucial thing is to ensure that there are sufficient supplies for epidemic protection such as medical masks, disinfectants, and temperature measuring instruments.

Third, establish the management system of care workers during the epidemic. The prevention and control work of COVID-19 is aimed to prevent and control the spread of the virus at all costs and to ensure the safety and health of patients and the public. Therefore, it is important to guide all the nursing workers to cooperate with the closed management of the ward. They are required to cooperate with the closed management of the ward, and coordinate with the department to make registration and filing. They should monitor the body temperature together with the medical staff according to the requirements, and report the body temperature and physical condition truthfully.At the same time, we will further implement the code of nursing. Under the closed management mode of the ward,we continue to implement the patient-centered nursing standards to ensure the safety of patients.

STRENGTHENING THE KNOWLEDGE TRAINING OF EPIDEMIC PREVENTION AND CONTROL AND IMPROVING THE SELF‑PROTECTION ABILITY OF CARE WORKERS

COVID-19 is mainly transmitted through respiratory droplet transmission and close contact.[1]When people are talking, coughing, sneezing, or even breathing, they will release droplets into the air. Therefore, taking necessary personal protective measures to prevent the spread of respiratory droplets is conducive to the health of patients and workers as well as epidemic prevention and control.The simplest and most effective way is to wear a mask.Some studies have shown that even ordinary medical masks and surgical masks can block 70% of influenza virus droplets.[7]Good hand hygiene is the second effective way to prevent infectious diseases after wearing masks.However, the rate of hand washing of medical staff and nursing workers in hospitals at home and abroad is low.Most of the nursing workers do not have the habit of hand washing before and after contacting patients.[8,9]Pittet et al. showed that 30% of nosocomial infections were caused by direct or indirect contact with pathogens.[10]A coronavirus nucleic acid was detected in the feces and surrounding environment of COVID-19 patients.[1]As nurses need to have close contact with their patients and their surrounding environment, strengthening hand hygiene management of hospital care workers, introducing proper hand washing methods for church nurses, and the right timing of handshake are important for preventing contact transmission.

The nursing department and the infection office of our hospital jointly developed the epidemic prevention training course and adopted the methods of online distribution of relevant materials on WeChat platform, on-site teaching in batches for the staff of publicity training group and the nursing staff of the department. To explain the significance of closed management of COVID-19 during the epidemic prevention and control and the knowledge of the harm and transmission routes of the virus, we focus on protective skills, training of respirators, masks, hand hygiene, and garbage sorting. Moreover, all of our personnel are required to pass the examination. This kind of training ensures that they have access of relevant knowledge for it is updated online in WeChat group. At the same time, each department is required to conduct at least one on site training for each care worker in the ward once a week ,arrange the time and place in the ventilation corridor properly to avoid personnel gathering and ensure that the distance between people is at least 1 meter for personnel protection as well.

IMPLEMENTING SUPERVISION AND ASSESSMENT TO ENSURE THE SAFETY PROTECTION OF CARE WORKERS

The members of the supervision group of the nursing department shall conduct supervision and assessment on the protection workers of each department at least twice a week by means of on-site supervision or online video supervision. The supervision contents mainly include the following points: (1) As for instruments, whether care workers wear masks, disposable work caps, and work clothes as required. (2) Whether care workers master skills such as seven-step hand washing, wearing masks, and garbage sorting. The seven-step hand washing technique requires time, sequence, and method to reach the standard. (3)Whether labor discipline is made, such as shift, off post,and gathering. (4) Whether care conduct self-monitoring and report truthfully without any false report, omission,or concealment as required. The degree of satisfaction of supervision is related to the salary performance of the care workers. At the same time, the opportunity of correcting the errors is given to the care workers. The problems found in the supervision shall be corrected from the perspective of the understanding of the care workers.

IMPLEMENTING HUMANIZED MANAGEMENT AND PAYING ATTENTION TO THE PHYSICAL AND MENTAL HEALTH OF CARE WORKERS

The humanized nursing management method can optimize the management work, improve the professional level of the staff, and make them feel more caring. Thus, they pass on the care to patients so as to increase the satisfaction between the nursing staff and patients.[11,12]Due to the closed management during the epidemic period, nurses are prone to burnout,anxiety, and other adverse emotions in the closed working environment for a long time. The nursing department cares about and helps the nursing workers in work, life, and ideology, e.g., helping them to solve practical difficulties by understanding their needs and guaranteeing their daily life needs as required through cooperation with the logistics department, so that the nursing workers can maintain a positive and optimistic attitude and concentrate on their work. The department establishes a reward mechanism for care workers to improve their initiative according to their work conditions, nurse feedback, patient feedback,and assessment results of epidemic prevention knowledge and skills. In addition, guiding the care workers to get out of negative moods by empathy: (1) Indoor entertainment activities according to personal interests, hobbies, leisure time, such as listening to relaxing music, watching comedy films, and TV, so as to make them feel lighter. (2) Exercise is great. The suitable exercise is helpful to relieve bad moods, improve physical fitness, and enhance immunity.[13]Prof. Ren-He Lyu, a Chinese medical master in our hospital,combined the Baduanjin, Tai Chi, and other sports techniques with his many years of clinical experience to make up a small amount of 18 Duanjin (18 section brocade) exercise, which only need about 2 m2to practice.[14]The Ministry of Nursing will promote the 18 section brocade to the care workers,distribute practice guidance videos, advocate moderate exercise after work, and thus combine work with rest and enhance physique.

The prevention and control of COVID-19 among patient carers play an important part in preventing nosocomial infection. In the process of epidemic prevention, the management measures abovementioned help the popularization of basic knowledge of COVID-19, so the protection consciousness is significantly enhanced than before training. We have completely grasped the methods of hand hygiene, the methods of picking and wearing masks, and the simple garbage sorting method, which provided a guarantee for the prevention and control of epidemic situation in hospital. As COVID-19 is effectively controlled in China, the hospital needs further management of the hospitalized patients and nursing workers in a new-stage epidemic prevention and control to protect the needs of the majority of patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.