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Preparing the Frontline: The Role of Nursing Education in the Fight against COVID19 Pandemic – The KFSH&RC Experience

Goncalo Placido

The beginning of 2020 set the whole globe to a test. Healthcare systems, healthcare professionals worldwide, most importantly nurses, were put face to face with a health challenge of massive proportions: the COVID19 epidemic. According to the World Health Organization (WHO), by the end of June 2020, nearly halfyear since the beginning of the mentioned pandemic, approximately 8,5 million cases of infection and 450.000 deaths by Coronavirus had already been registered globally. Despite all the major efforts to maintain the virus outside its boarders, also the Kingdom of Saudi Arabia was affected by this scenario, having identified the first infected person on March 2020. According to the same source, in the same period of time, the number of cases in the Kingdom was as high as 146.000. In Riyadh, King Faisal Specialist Hospital and Research Center (KFSH&RC) is a renowned 1600-bedded tertiary referral hospital that provides the highest level of specialized healthcare, recognized as one of the leading healthcare organizations in the Middle East. At present, its Nursing workforce is composed of an average number of 5000 nursing professionals. These healthcare providers have always been the first and last line of defense, and surely continue to be during this time of uncertainty and fear of the unknown. Being the backbone of any Healthcare system around the world, nurses are key to prevent the spread of infections by ensuring all aspects of nursing care are properly conducted. Furthermore, as Healthcare is now expanding in complexity, the Nursing professionals need to be prepared to broad their roles. As an anticipation of an admission surge at KFSH&RC, the Nursing Education Department, aligned with the Institution’s Strategy, structured and implemented a plan which upskilled the Nursing Team, preparing the nurses to work in unfamiliar environments, in clinical settings outside their usual practice. The plan was organized in three dimensions as follows: First dimension: General Awareness of Infection Control Standards Compliance with Infection Control core standards is absolutely essential to prevent cross-contamination between healthcare professionals and patients. Several initiatives took place within the hospital premises to increase awareness of the importance of following the Infection Control procedures at all times. These initiaves included virtual meetings, Intitutional push messages, videos of ‘Do’s and Don’ts in Infection Control’ displayed in all Hospital screens, sharing of Infection Control Policies and Procedures to all Hospital employees, and competencies checkoffs for hand hygiene and appropriate usage of Personal Protective Equipment (PPE) – specially in ‘COVID areas’. Second dimension: Upskilling of Nurses from Outpatient to Inpatient settings Considering the infection rate in the region, all the outpatient clinics were closed to allow the nursing staff to support the inpatient units. Having never experienced to work in an inpatient area, these staff were floated to several units where they underwent a one-week one-to-one orientation process with the Clinical Instructors. This preceptorship included competencies check-offs of general nursing interventions such as Intravenous cannulation, blood and blood products administration, oxygen therapy, enteral feeding and management of central lines; orientation to the unit’s dynamics and nursing documentation. Third dimension: Upskilling of Nurses from Inpatient to Intensive Care settings To achieve the goal of preparing nurses from general inpatient settings to work in Intensive Care Units (ICU), a rapid ICU cross training was designed and implemented. This 3-day course was divided into two components: theoretical and clinical exposure. The classroom/theoretical component included topics such as Invasive Ventilation, hemodynamic monitoring, Sedation/rapid sequence intubation, arterial blood gases and Inotropes. After these lectures were completed, the nurses were taken to an ICU setting to practice and to be checked-off for the mentioned competencies. If sucessful, the nurses were taken back to the ‘home units’ on a stand-by status. Better trained staff prepares the Hospital for a further escalation of the number of infected patients admitted. Considering this fact, after implemention and conclusion of the mentioned plan, the Nursing Education Department and Nursing Affairs in general, were able to train and develop 1058 extra nurses ready to work in Intensive Care Units and allowed the Hospital to extend its capacity with a total of 482 ICU extra beds to face COVID19 Pandemic.