Portal de Periódicos da CAPES

Nurses in Conflict: Providing Care in Extraordinary Times

2020; Elsevier BV; Volume: 35; Issue: 3 Linguagem: Inglês

10.1016/j.jopan.2020.03.007

1532-8473

Maureen Iacono,

Migration, Health and Trauma

Information regarding the coronavirus disease 2019 (COVID-19) pandemic overwhelms and continues to alter the realities and norms of daily life. A barrage of information assaults us, or at least confronts what we knew to be true just last week. Vast amounts of information can be accessed in printed form or on the continual news feeds provided in various forms and formats for consumption. Web pages, social media platforms, and electronic mail bombards us during the rapidly evolving crisis. This information may be factual and presented by respected experts, or may merely be opinion. It can be veiled as cynicism or sensationalized to promote reactions, whether they evoke more judicious adherence to new restrictions and mandates, or further foster worry and fear. Nurses are not immune to being overwhelmed, frustrated, worried, and confused. No matter how much a nurses' identity can be articulated by being a nurse, the reality is that a nurse is a person first—a family member, responsible for self and others in relationships that absolutely matter. How can nurses deal with fundamental issues of taking care of self and loved ones and resolve the conflicts inherent with the complexities and challenges of workplace demands? There is a paradoxical pull to care for self and family and stay committed to community (our colleagues, patients, and their families). It is not business as normal. Nurses have a duty, albeit a calling, to answer the call to care for patients. This is fundamental decision making—answer the call, go to the workplace, and perform your job to the best of your ability, while providing financial support to your family. Yes, it is risky and uncertain, and causes anxiety. But it is also noble and honorable. And you are needed, essential, important, and unique. Every day your decisions matter. This moment in history is a defining one, and you continue to answer the call. The workplace needs you. It is scary to be essential. The wisdom of promoting self-care cannot be overstated. It is imperative that nurses (and our colleagues in health care, in so many important and intersecting roles) are actively working on routine and innovative methods of maintaining and promoting health and embracing all opportunities to strengthen mind, body, and spirit. Caring for self must extend to your personal, at home family unit, as the support and quality of life for your own core of strength comes from your own people. And let us face it, your family needs you. That need is current but extends into the future—and yes, hopefully, we look forward to the health of our families, patients, as well as local and global communities. We look forward to having our needs, and our families and patients' needs being met more predictably and more normally as the pandemic subsides. Care for yourself now, because proper rest, nutrition, exercise, and spiritual nurturing cannot be put off for another day. The American Society of Perianesthesia Nurses (ASPAN) has posted information on our web site for nurses in our specialty. Access the COVID-19 Toolkit today, and pay particular attention to the section on caring for yourself (www.aspan.org). In addition to self-care, extend yourself in relationships in the workplace. Get out of your bubble, whether it be political, territorial, or your work clique. Why does this help? We are all one community right now, an evolving community. Colleagues who may have frustrated or annoyed you could be a potential source of solace. And you may be a source of solace for them. New possibilities are presenting themselves. Seek out a friend, a mentor, and/or an advisor to get through difficult situations, and share anxieties and triumphs. Allow yourself to be real with someone. Stay invested and committed to support each other and to face the challenges of the swiftly changing workplace together. Humor can be essential to facing the issues of the day and the changing priorities as they arise. When possible, find and share the amazingly funny and candid videos, memes, and cartoons that clever people create and share freely. Maintain healthy relationships and avoid the truly negative unproductive people who only bring you down. Seek spiritual guidance and renewal. It is a good time to pray! But if you are not a person who embraces personal prayer, be assured, there are people you know and many you do not know who are already praying for you. They pray softly and openly. They are visible and invisible, and they support you. There are multiple resources, hotlines for crisis intervention when and if you are overwhelmed. The National Suicide Prevention Lifeline phone number is 1 800 273 8255. A crisis hotline is available by texting; text HOME to 741741 for help. Access phone applications such as the Calm application, and search for offerings to assist with meditation and breathing exercises. Maintain and refresh your competencies, with a specific focus on airway, ventilation, and ventilator function, both basic and complex. Update and practice with your colleagues to be prepared when the need arises and your skills are required more acutely. The ASPAN toolkit provides a sensible directive related to following standards of care. Clearly, as far as it is practical and as much as you are able, follow the standards of care for perianesthesia nursing. But some nurses will be asked/told to work in different surroundings with little to no preparation. It is then prudent to follow institutional standards of care for this pandemic as defined by your workplace. Who is there for you? Who can you listen to? Who can you trust? Seek and follow information that is evidence based. There is an abundance of accessible information posted online, in a truly collaborative and generous manner, as professional organizations are sharing essential resource information. It is a hallmark of professionalism to share freely with little concern about membership or selectivity. Nursing resources are increasingly available, and I recommend the American Association of Critical Care Nurses (www.aacn.org) Web site which, at this time, provides free access on demand to crosstraining information in the form of recorded webinars regarding treating patients with COVID-19. The Society for Critical Care Medicine (www.sccm.org) has posted a handbook regarding preparing intensive care units for disaster response. The American Association of Nurse Anesthetists (www.aana.com) also has helpful information, including a list of resources for further inquiry. Continue to seek information from trusted resources, and share this information with your colleagues. Expect to find more resource information in an ongoing manner on the ASPAN web site and on the Journal of Perianesthesia Nursing (www.jopan.org) web site. Remember that you, and your words, are important to others; you have influence and gravity because your words have power. What you hear might or might not be based on factual information; be extremely careful in repeating something that is misrepresented or misinterpreted. You are respected, and you are counted on to do right, and now also to say it right; if you restate information that you think is factual, be certain that you give it attribution. The Centers for Disease Control (www.cdc.org) now says … "Information currently on the National Institute for Health (www.nih.org) indicates …" "My current belief is that we do/do not have to wear masks while providing routine care and I base my belief on information from …." Give your source. In general, information you hear can be based on fact or on opinion. Try to find out the source of information you receive in your workplace before you believe it, adopt it, and repeat it. In a crisis situation such as this, if you have trusted a leader or authority figure in your institution in the past, trust them now. The team is in this together, seeking clarity and reclarification while navigating through the crisis. Trust involves some contrast between lofty hopes and desires and deepest worries and fears. The human connection involves some fragility and some leeway to redirect the courses of action currently established for this pandemic. It also requires trust. No one knows all the answers, but many are working hard to get it right. Be part of the team that gets it right. I have often amused my family (perhaps annoyed them) while watching or attending sporting events. I enjoy them and I can and do scream loudly and with gusto. But I also comment and lament (apparently frequently) that we need to bring cheers and loud acclaim to the feats of nurses and esteemed health care workers. So, you made an amazing three pointer? So, you pulled off two hat tricks in a row? So, you ran that ball down the entire field without tackle? I have always wanted the community at large, the masses, to recognize and celebrate the unbelievable heroic care and caring of the ordinary nurse in extraordinary times. Your time is now. In this unparalleled moment, nursing altruism is actually recognized and acclaimed. The laudatory commentaries and anecdotes are highlighted by news anchors. Can you hear the thank you, the pride, the respect and yes, the cheers? Sing the praises of nurses! There are communities designating a specific time each day that neighbors and family members open their windows and find ways to cheer, yell, clap for you and your fellow heroes in health care. It is resounding, an uplifting enormous thank you for what you do and how you do it. Celebrate the attention; it is well deserved. You, the nurse, are integral to weave the new reality of our tomorrow. I am so proud that the crowd is roaring. If community is really based on trusting each other, you continue to earn that trust as you support and care for your community.