Scoping Review: What Is the Role of Nurses in the Era of the Global COVID-19 Pandemic?
Dear Editor:
The year 2020 marks the 200th anniversary of Florence Nightingale's birth, an event that has sparked enhanced focus on the potential of the nursing profession.1 Currently, in many parts of the world, the coronavirus disease 2019 (COVID-19) pandemic has left many individuals living under numerous constraints and fighting the fear of death. Responding to this conjuncture, we conducted a novel rapid review of the role of nurses during the COVID-19 pandemic.
We conducted a scoping review using the PRISMA-ScR checklist.2 We searched PubMed, CINAHL, Scopus, and Web of Science from January 1, 2019 to May 3, 2020. The search terms included “COVID-19 OR coronavirus OR SARS-CoV-2” and “nurse OR nursing OR care.” The inclusion criteria were (1) any article describing COVID-19; (2) any article describing nurses' practice management, care, or role; and (3) articles written in English. Articles that broadly involved health care workers and not only nurses were excluded.
A total of 810 potential articles were identified through database searches (Supplementary Fig. S1). We excluded 134 and 562 articles owing to duplication and based on our assessment of their titles and abstracts, respectively. Finally, we included 11 articles in the review. Details of these articles are provided in Supplementary Table S1. Table 1 shows the type of the nurse's role and specific examples from selected articles. We identified five categories for the themes of nurses' roles: managing the influence on routine clinical practice (n = 5), symptom management (n = 3), infection management (n = 3), ensuring the quality of nursing care (n = 2), and psychological support for nurses (n = 1).
| The type of the nurse's role | Specific examples |
|---|---|
| Managing the influence on routine clinical practice | Explain why a nonemergency scheduled medical examination was cancelled |
| Delegate duties to nonspecialty nurses because of a lack of manpower due to care for severely ill COVID-19 patients | |
| Symptom management | Managing breathlessness: Controlled breathing techniques, including positioning, pursed-lip breathing, breathing exercises, and coordinated breathing training |
| Nursing related to oxygen therapy, medication, nutritional support, psychological support, and condition monitoring | |
| Infection management | Disposable cap, surgical mask, gown, face shield or goggles, protective clothing outside the work clothing (such as a white coat), medical rubber gloves, and hand sanitizer |
| Provide intense education and training that includes the use of personal protective equipment, hand hygiene, ward disinfection, and so on; establish a scientific and reasonable shift schedule; and take full advantage of the infection control system. | |
| Ensuring the quality of nursing care | Director of nursing: Ensure adequate and appropriate nursing staff, implement and ensure that policies and procedures are adhered to, ensure education of the nursing staff, oversee the infection control practitioner, and assist the administrator in the coordination of quality improvement activities. |
| Psychological support for nurses | Head nurse: To relieve their mental stress, conduct a 30-minute meeting with nurses who will work in the isolation area. If they feel any discomfort (e.g., anxiety or sleeplessness), make adjustments to obtain professional support. |
First, we found that managing the influence on routine clinical practice was most frequently described (5 of 11 articles). For example, in an anticancer treatment setting, nurses screened for COVID-19 over the phone for patients scheduled to receive anticancer treatment at an outpatient treatment center.3 Patients suspected of having a COVID-19 infection may be treated in a separate room from other patients or according to a modified schedule. This may require an adjustment in the number of patients that can be treated per day. Furthermore, this is also true for radiation therapy and surgery, not only chemotherapy.
Second, in terms of the nurses' role, symptom management received as much attention as infection management (3 of 11 articles). For COVID-19 patients, nurses are expected to manage dyspnea.4 During this management, it is important for the patient to acquire a sense of control over their breathing; nurses can help patients by teaching breathing techniques to manage dyspnea.
Finally, there was only one description of psychological support for nurses helping COVID-19 patients5; however, we believe that this is a particularly significant role for them. It is important for nurses to note that the person who supports someone potentially needs help the most. Not only patients and their families but also nurses and medical staff, as caregivers in strenuous work environments, require psychological support. Although the pandemic places high expectations on nursing professionals, supporting them is also an important theme.
Supplementary Material
Supplementary References
References
- 1.
World Health Organization: Year of the nurse and the midwife 2020 . https://www.who.int/news-room/campaigns/year-of-the-nurse-and-the-midwife-2020. (Last accessedMay 18, 2020 ). Google Scholar - 2. : PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med 2018;169:467–473. Crossref, Medline, Google Scholar
- 3. : COVID-19 prevention and care: A cancer specific guideline. Arch Iran Med 2020;23:255–264. Crossref, Medline, Google Scholar
- 4. S Improvement. Managing COVID-19 symptoms (including at the end of life) in the community: Summary of NICE guidelines. BMJ 2020;369:m1461. Medline, Google Scholar
- 5. : Special attention to nurses' protection during the COVID-19 epidemic. Crit Care 2020;24:120. Crossref, Medline, Google Scholar
