Thursday, 2 April 2020

COVID-19. There is no more time: alert from Italian nurses

Giancarlo Cicolini
Department of Biomedical Science and Human Oncology
University Of Bari "Aldo Moro", Bari, Italy

Paola Arcadi
University of Study of Milan
ASST Ovest Milanese, Milano, Italy

Valentina Simonetti
Politecnica delle Marche University
Ascoli Piceno, Italy
Email: Valentina Simonetti

The new form of Coronavirus (2019-nCoV), has spread throughout China with more than 81000 confirmed cases and affected Countries and territories worldwide. Coronavirus disease (COVID-2019) and has rapidly evolved in the globe as a Pandemic. To date, China and Italy are involved with more confirmed cases in the world, 81.439 and 59.138 cases, respectively, with a surprising increase of Italians’ deaths (5.476) if compared to Chinese ones (3.274). However, Italian data should be taken with caution, because it refers to the lethality rate, not to the mortality ones, and depends on the positive subjects resulting to Covid-test. Anyway, despite more restrictive measures to reduce the spread of the coronavirus, viral diffusion seems to continue, some hospitals resulted “overwhelmed”, with differences among Regions of the North, the Centre and the South of Italy on the way to operate at more than maximum capacity for many months, also due to the health care federalism. 

In general, in Italy a lot of hospitals have been reorganized, as Hospital Covid and No-Covid, to support pandemic situation, granting dedicate path for infected and non-infected patients, and front-line healthcare workers are engaged to support an overworking in a weak situation. However, the same problems are shared on various contexts, both extra and intra-hospitals: ventilators, personal protective equipment (PPE) are insufficient all over the Country. Nurses are forced to reuse PPE at work, because they are scarce, both in hospital and on primary healthcare service. Often, in many settings, those available are not suitable. Also, in this situational framework, both patients and front-line healthcare workers are vulnerable to the emotional impact of Coronavirus, and their needs should be considered. A lot of anxiety is registered both by citizens and healthcare workers due to the virus containing measures adopted by the Government, in according with WHO recommendations as: social distancing policies, schools, industries, offices, stores closures, and to be in quarantine at home. Among healthcare workers, an increase of psychological problems during this epidemic, including anxiety, depression, and stress have been noted and should be considered. Healthcare workers are also concerned both for their personal safety and for those of their families: the risk to pass the infection to relatives is high, especially for those who take care for elderly parents. Another stressing factor is that they are often asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the tension of those on the front line. They are also frustrated for the unawareness of people about the potential risks caused by the lack of compliance with the quarantine. In the workplace, nurses’ shifts are longer and exhausting because of nurses and physicians’ shortage, that is now evident in the Italian context. In fact, nursing workload in Italy is high: nursing staffing shows a patient-nurse ratio of 1 to 9.54, with a variable range from 7.08 to a maximum of 13.65. This represents a worrying data if compared with the average range 1: 6 reported in international contexts, probably leading to negative consequences for patient safety (in terms of mortality and morbidity) and nurses’ satisfaction, stress, burnout and intention to leave.

Italian healthcare system is trying to manage this situation with new hiring staff, but neither doctors nor nurses are not sufficient to fill this shortage. Another problem is related to the novice staff needing to be trained before being hired, but there is no time to do it. This could negatively affect a safe assistance delivery, both for themselves and for citizens. In conclusion, our Italian experience on strategies to manage this terrible pandemic, suggests that patient cooperation remains the key to limiting the spread of COVID-19, both in Italy and worldwide. Also, the healthcare system should be prepared to afford this sanitary emergency by adopting a proactive approach in order to prevent and contain the Coronavirus spread.

At this purpose, a new hospitals organization providing a suitable number of beds in intensive and sub-intensive therapy, adequate provision of medical aids as artificial ventilation machines, PPE and a suitable number of qualified nurses and physicians are needed, also to support the healthcare sustainability. Only preventive interventions may reduce Chinese and Italian deaths and number of positive health care workers. Italian nurses’ experience shows critical points that should be considered by other Countries that are facing this emergency now: to prioritise resources, revise hospitals organization, provide psychological support to healthcare workers and families, in order to mitigate viral propagation and contain, as much as possible, death rates, economic recession and negative psychological consequences on healthcare workers that will likely occur when this pandemic disaster till the end.

There is no more time: this is the cry of the Italian nurses, which requires to be listened to.

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