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Into the red zone: behind the mask of a cardiology nurse fighting COVID-19

2020; MA Healthcare; Volume: 15; Issue: 9 Linguagem: Inglês

10.12968/bjca.2020.0112

2052-2207

Sadie Carpenter,

COVID-19 Pandemic Impacts

British Journal of Cardiac NursingVol. 15, No. 9 ReflectionFree AccessInto the red zone: behind the mask of a cardiology nurse fighting COVID-19Sadie CarpenterSadie CarpenterCorrespondence to: Sadie Carpenter; E-mail Address: [email protected]Royal Brompton and Harefield NHS Foundation Trust, Middlesex, UKSadie CarpenterPublished Online:17 Sep 2020https://doi.org/10.12968/bjca.2020.0112AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail On 23 March 2020, Prime Minister Boris Johnson put the UK on lockdown to curb the spread of the coronavirus pandemic with the slogan: 'Stay at home, protect the NHS, save lives'. Health Secretary, Matt Hancock, said at that time: 'we are in a war against an invisible killer'. This lockdown announcement was reminiscent of Prime Minister Winston Churchill's announcement on 4 June 1940 when the nation was going to war: 'we shall fight them on the beaches'.Nurses had become soldiers, headed to the frontline in a war against COVID-19. Following the lockdown announcement, there were numerous changes to our NHS hospital—in particular, the ward environment. From donning, doffing, shielding and self-isolating, to social distancing, the red zone and personal protective equipment (PPE), there was no shortage of new terminology for nurses to become familiar with. Some of my nursing colleagues were 'shielding', others were self-isolating and, sadly, as time progressed some had contracted the virus and were recuperating with their families.Sadie Carpenter pushed through the heat and claustrophobia behind her mask to fulfil her nursing duty of care to patients with COVID-19The red zoneI clearly remember the day I came in to work and was allocated duties in the 'red zone', a ward within the hospital designated to nurse patients with COVID-19. The ward had been completely transformed to accommodate and provide nursing care for these patients. The entrance had been altered by adding in an extra set of double doors. Upon entering the first set of double doors, there was a 'donning area' to my right with an allocated healthcare assistant to help staff don the necessary PPE. The PPE was laid out in sections, with a gown, mask, visor, two sets of gloves and hand sanitiser.After applying the PPE, I immediately felt hot and claustrophobic. This sensation of heat coupled with an overwhelming feeling of claustrophobia made me want to refuse to carry on with my nursing duties, but I took a deep breath and soldiered on. The healthcare assistant in the donning station taped my name to the PPE; otherwise no one would recognise me. The only parts of my body that were exposed were my eyes.I pushed through the second set of double doors and barely recognised the ward area. There was a sink immediately to my right outside the 'doffing' area. There were yellow arrows pointing me in the direction of the nurse's station. Some areas of the floor were also taped to divide sections of the foot flow to maintain social distancing among the patients and staff. There was an eerie silence, which made me feel apprehensive about what the day might bring.Behind the maskEverything seemed surreal and some of my senses were dampened by wearing the PPE. Talking was more difficult behind the mask. I definitely could not drink or eat so my mouth felt dry. My sense of smell was weakened as the mask covered my nose and my vision was impaired by the visor, but my hearing seemed to be enhanced. This may have been because the ward was a lot quieter; health professionals were not entering the ward unless there was a clinical reason for them to do so. All I could feel was incredible heat and I knew that my nursing duties would take a lot longer to carry out as my energy would be drained from wearing the PPE.After introducing myself, recognising my colleagues, and establishing who was on duty for that particular shift, I was given a brief safety handover by the nurse in charge and allocated patients to look after. I had barely commenced my shift and had no patient contact, but I was already feeling hot, breathless and anxious.As I was already familiar with the ward routine, I commenced the medication administration round after taking the nursing handover from the night duty nurses. There was a new IT system installed with the patients' prescribed medication. One of my colleagues demonstrated how the system worked and I carried on dispensing the medication. The keys for the patients' medication were placed on hooks at the nursing station.Patient careDispensing medication took a lot longer than anticipated as I was using a new system and dispensing medications to a caseload of patients who were from different nursing specialties. My prior experience mainly consisted of nursing cardiology patients, and the allocated caseload was now predominantly respiratory and post heart and lung transplant patients.Following the medication round, my nursing colleagues and I focused on ensuring our patients had their breakfast. Some required their food and fluid intake and output logged on the new system. The patients' vital signs were also taken and inputted, then nursing duties were concentrated on assisting patients with their hygiene needs.This was not an easy task considering my temperature inside the PPE was at boiling point and it became increasingly difficult for me to breathe. However, I managed to ensure that the patients had assistance with washing and dressing, and were made as comfortable as possible. Following their wash, they were either assisted to sit out in an armchair or helped back to a clean bed. Some weaker patients needed to be washed and dressed while in bed, which was a task requiring two or three nurses.You may well call the patients who survived intensive care the 'walking wounded'. They endured a traumatic episode, requiring a ventilator to do the work their lungs would normally do. Their vital organs were supported in order for the intensive care team to treat them and save their lives. Our patients were now able to talk, eat, drink and use the toilet.Our needsHowever, as our patients recovered these abilities, I remained unable to carry out these basic bodily functions while inside the red zone. I was not allowed to take off the mask, so talking was difficult. I certainly could not eat or drink anything. The toilet was outside the red zone, so I would have to doff the PPE and go outside the zone to use the toilet. I was conscious of managing my time so that I could have these comfort breaks according to my physical needs but also around patient care. Every day, I heard in the media that there was a shortage of PPE and that in order for me to drink, eat or go to the toilet, I needed to doff the PPE, and leave the ward area.Generous food and drinks were donated to us by the public. Our staff restaurant served free food. Airline staff, who were furloughed during this pandemic, even set up a first-class lounge experience for our staff called Project Wingman. The airline crew selflessly transformed one of our restaurants into a comfortable lounge where we could go on our breaks to relax, read a newspaper or magazine, and be served with snacks and drinks before we returned to our duties at the hospital.This was a lovely experience and it made me reflect on how very different the nation was fed during World War Two. They had ration books and were only allowed a small portion of food to keep them alive. I ensured that I drank very little on my break, had something to eat, and felt refreshed before I returned to the ward.CamaraderieDespite all of these transformations on the ward and our alterations to nursing care to fight the pandemic, I felt a great camaraderie among the nursing staff. As well as the nurses who routinely worked on the ward, there were nurses deployed from other areas of the hospital that I had not worked with for many years. I was hearing a mixture of comments from 'I haven't worked on the ward for 12 years' to 'can you show me how to input data on this new IT system'. Overall, we pulled together and worked extremely well as a team. There was a fighting spirit among us, with the ultimate goal of seeing our patients get well again and go home to their families.Furloughed airline staff set up a first-class lounge for NHS staff during the pandemicLoved onesOwing to restrictions on visitors, we were our patients' main contact with the outside world. Some of our nurses came forward and set up a call centre to pass messages from patients to their loved ones. These nurses came to the ward in their PPE to get regular updates on patients' progression and pass this information on to their relatives. These nurses also spent time with the patients to enhance communication with their families, and set up Skype calls to ensure visual contact between patients and their relatives.We were fortunate enough to have a beautiful garden in our hospital grounds. As time progressed, I managed to escort a patient to the garden and his family was able to speak to him from the other side of the fence. This was arranged by the nursing team in the call centre.Road to recoveryDespite feeling so uncomfortable in the PPE, the one thing that kept me going was that the patients had come through the worst of their illness and we were all pulling together in a great team effort to maintain and improve their health. These patients had been asleep and very sick for weeks. This was an extremely traumatic experience for them. They were now on the road to recovery and, as a nurse, I was determined to keep going and help them on this journey. They spoke hoarsely, had lost a lot of muscle mass and were very weak and fragile. Simple tasks such as walking and talking were arduous for them. Their anxiety levels were high and I did whatever I could to help alleviate these feelings and make them feel as comfortable as possible.Well-oiled machineThe other members of the multidisciplinary team came to the ward when it was necessary to assist in patient care. The consultant-led doctors' rounds were succinct and covered the management of each patient thoroughly with a ward round in the morning and one in the afternoon. Other health professionals such as physiotherapists, psychologists, pharmacists and phlebotomists came and went according to patient requirements.The catering and domestic staff worked hard to ensure that patients had fresh food every day and the ward was kept scrupulously clean. Other supportive staff within the hospital communicated with us via telephone to assist with bringing any necessary equipment and blood result analysis, and ensured we had everything at hand to enable us to nurse the patients. I felt proud to be part of an excellent team working in a specialist hospital trust. We were working like a well-oiled machine, fighting COVID-19 on the frontline.Moments and memoriesIn my nursing care of the patients, some key moments stayed with me. One memory was assisting a 34-year-old man have a shower, which was an activity of daily living that he would have been independent in doing and taken for granted. I was assisted with this task by another nurse, and although it was inevitably not a very dignified experience for the patient, we maintained his dignity as much as possible.I also attempted to relieve his anxiety about when he may be able to return home to his wife and son. I encouraged him to get strong and return to a lively 3-year old, who would most likely want to leap on his father's lap and play with him, when he went home. He expressed his concern that he was missing his wife and son's birthdays. I said that those days could be celebrated later in the year, perhaps with a family picnic. The key message was that he needed to be strong and healthy enough to return to his loved ones. He already had a relapse in our hospital, as he had been ventilated and had to be re-ventilated, when his health deteriorated. It was also very emotional to see him regain his strength and be able to walk around the ward. He eventually went home to be with his wife and son.Another memory was seeing how frustrated a 65-year-old man was, to the point that he unplugged the air conditioning unit from his room, and closed the window. I am sure he felt like a 'caged animal' and all he could see were nurses around him looking like aliens in our PPE 'space suits'. I can only imagine how frightening this was. This was coupled with the fact that his relatives were not allowed to visit him and his only contact with the outside world was the staff in the red zone and a television in his room. I was singing to myself one day while I was getting his medication ready and he questioned why I was singing. I said 'what would be the point in me being miserable'? We were all in this fight together.Other patients I looked after ranged from 30–88 years of age. I have clear memories of the nursing care I provided and the conversations I had with each one of them, and it is so reassuring to know that they all went home to their families.There were emotional scenes when the patients were well enough to return home. The patients were 'clapped out' of the hospital. This gave everyone a great sense of pride, purpose and achievement. The patients were in tears and uttering words of 'thank you, I owe you all my life'. The general feeling from the public was one of admiration and appreciation for what health professionals are doing, and the bravery they have displayed during this global pandemic.Better days?In the Queen's speech, she thanked everyone on the NHS frontline who selflessly continue their day-to-day duties outside their homes in support of the nation. Her message was very clear: 'we will succeed and better days will come'.Throughout the pandemic, my anxiety was heightened as key members of society and the government contracted the virus. Prince Charles had tested positive; Boris Johnson was hospitalised; and the Health Secretary, Matt Hancock, also displayed symptoms and had to self-isolate.I was acutely aware of my own health and the wellbeing of my family, friends and loved ones. I was also concerned for my nursing colleagues, who were shielding, self-isolating and unwell with the virus. Testing for the virus is rigorously carried out at our NHS hospital and any member of staff displaying any signs and symptoms of COVID-19 are offered the opportunity to be tested.On Friday 8 May, I celebrated Victory for Europe (VE) Day with my neighbours with a socially-distanced picnic on our front lawn. This commemorated the 75th anniversary of the end of the war in Europe. I couldn't help thinking, 'when will the war end for the nurse behind a mask fighting COVID-19?'The Red Arrows still undertook their fly-past and there was a 2-minute silence at 11 am with parts of Winston Churchill's speech announcing the end of World War II. I wonder what our celebration will be when the COVID-19 war is over—or whether it will ever really end.Saving livesAs the message from the government changed on 20 May to: 'Stay alert, control the virus, save lives'; I think this is what every nurse has always done and continues to do in their daily duties in the NHS. Although we have not always been fighting a global pandemic, we have always been fighting and controlling other infections.I am proud to work in a specialist global NHS trust that treats cardiology and respiratory patients, while providing excellent nursing care. Our message is clear: we are proud to provide a lifetime of specialist care and save lives, whatever infection risk or virus comes our way.Acknowledgements:The author would like to thank Alison Pottle, Consultant Nurse in Cardiology; Dr Miles Dalby, Consultant Cardiologist; Dr Sundeep Kaul, Consultant in Intensive Care and Respiratory Medicine and Felicia Cox, Lead Nurse in Pain Management, for their kind support, encouragement and feedback on this personal reflection. FiguresReferencesRelatedDetailsCited byPandemic diariesAysha Mendes1 February 2022 | British Journal of Cardiac Nursing, Vol. 17, No. 1Under pressure: an ode to nurses and patientsAysha Mendes26 May 2021 | British Journal of Cardiac Nursing, Vol. 16, No. 5COVID-19 fatigue and caring for our mental healthAysha Mendes30 October 2020 | British Journal of Cardiac Nursing, Vol. 15, No. 10 2 September 2020Volume 15Issue 9ISSN (online): 2052-2207 Metrics History Published online 17 September 2020 Published in print 2 September 2020 Information© MA Healthcare LimitedAcknowledgements:The author would like to thank Alison Pottle, Consultant Nurse in Cardiology; Dr Miles Dalby, Consultant Cardiologist; Dr Sundeep Kaul, Consultant in Intensive Care and Respiratory Medicine and Felicia Cox, Lead Nurse in Pain Management, for their kind support, encouragement and feedback on this personal reflection.PDF download