Prioritize patients without hesitation

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Even a pandemic cannot stop frontline nurses from caring, and from turning that attention into action.

When deciding between keeping her own safety or providing the best care for her patient, Alexa Munguia, registered nurse, labor and delivery nurse at Lucile Packard Children’s Hospital in Stanford, did not hesitate. Her COVID-19 positive pregnant patient needed an emergency cesarean, and Munguia was there by her side.

“I didn’t want her to feel like a virus, like she couldn’t be touched,” Munguia says. “So I did what I always do when a mom needs help getting into the right hunched position for an epidural. I hugged her face to face.

During the procedure, Munguia kept reminding herself that she trusted her personal protective equipment (PPE) and training to keep her safe. She repeated the words “You are safe” to herself over and over again.

“It was second nature. If a patient needs me, I’m there, ”she says.

Fortunately, mom and baby have recovered very well. Munguia’s story is just one of hundreds that have unfolded within the walls of our hospital over the past year. Frontline workers have faced the pandemic head-on, with selflessness and courage. Take Michelle Tan, RN, Pediatric Intensive Care Unit (PICU), for example.

“I treated a child with COVID-19 who was very sick and kept getting worse. As nurses working with COVID-19 patients, we give ourselves breaks, but I chose to stay with the patient for three weeks in a row without a break because I knew the family and they knew me ” , Tan said. “I wanted to ensure this continuity of care.”

She had another extremely ill COVID-19 patient who was in intensive care and required extracorporeal membrane oxygenation (ECMO) to survive, the highest level of survival available. Not everyone who needs ECMO survives.

“The child surprised us and recovered very quickly. Seeing this patient leave the hospital was really great, ”adds Tan.

Face the risk

Nurses wear extensive PPE which must be put on and taken off correctly to prevent the transfer of possible virus particles. There is the N95 mask, much beefier than the average medical mask. Then the glasses, the face shield, the hairnet, the gown and the slippers.

“I’m hot, I’m sweating. My glasses are fogged up, ”Munguia says. “The N95 mask hurts my nose and I want to itch or rub. But I focus on what I’m doing and I keep going.

Despite its challenges, nurses welcome PPE. They know this is what they need to keep themselves and their patients safe.

“I know other California hospitals ran out of N95 masks and nurses had to wear them for days or multiple patients. But we always had a good supply, ”adds Tan.

While comprehensive protocols were quickly put in place to protect patients and staff, some staff exposure when caring for COVID-19 positive patients simply cannot be avoided. When a pregnant woman is in the process of giving birth, she blows and breaths and wants to lower her mask to get more air. She may have to bring her mask back to vomit.

“We have to be there to help a mom-to-be pushing, so we remind her to keep her mask on. In reality, as a staff nurse, you take a certain level of risk, ”says Munguia. “It’s scary, especially the thought that if I got sick I could pass it on to my family. But it’s my job and I love it, so I don’t hesitate.

Exposure can also occur when a nurse works hard and has to lift her glasses for a second to clear the fogging. Or, a patient or parent tests negative on admission but actually has COVID-19. This is the nature of patient care during a pandemic, and the sacrifices extend beyond the nurse to the family.

“At first there were so many unknowns so it was very scary. I have two young children. My husband and I had a plan so that if something went wrong, he and the kids would go live with my mom to isolate themselves from me, ”says Veronica Gutierrez, RN, MSN, for the COVID patient care unit. 19 from the hospital.

Gutierrez’s floor, which is physically separate from much of the hospital, has been turned into a COVID-19-positive unit with intensive care protocols – essentially a landing area for all positive patients or those waiting for test results. Some were extremely ill and had other health problems, such as cancer, cerebral palsy or appendicitis. When asked why she continued to work in the face of such a risk, she simply replied, if not her, then who?

“When there’s something huge like a pandemic, you don’t just think about yourself,” says Gutierrez. “And if everyone said no, then who would take care of the children?”

Fortunately, she never got sick and never had to send her husband or children away. She attributes the strict control her floor had over rules, visitors and staff.

“I firmly believe that we were the safest place in the hospital. We did not allow both parents to stand up, unless it was for special circumstances, which we needed to get approval for. We also didn’t allow parents to come and go. Our protocols were incredibly strict, ”she says.

The COVID-19 Special Patient Care Unit has been closed due to low COVID-19 counts and increased hospital-wide confidence in caring for patients on each floor. Innovative ideas have arisen from the unit, which will likely have sticky power after the pandemic subsides, such as installing an interpreter app on patient tablets for easy communication when an interpreter is not available, or use cameras and intercoms to talk to patients rather than always walking around their rooms.

Ensure patient safety while maintaining their comfort

Despite strict COVID-19 care protocols, Packard Children’s remains dedicated to high quality personal care. During labor and delivery, mothers who are positive for COVID-19 are usually separated from their babies. Yet staff know the incredible value of skin-to-skin time and breastfeeding for newborns. When an infected mother wants her baby to come closer, labor and delivery nurses empower her by placing her baby in an isolette in the room, which blocks germs and allows safe contact. Positive moms can also breastfeed. They wear a mask and the nurses wipe mum and baby before and after.

On the COVID-19 patient care unit, nurses have regularly advocated for the needs of patients. The rules of the special unit were that a parent could stay with a child, but he or she could not come and go, and the parents could not take turns. Gutierrez becomes moved to talk about a particular patient who didn’t speak English and whose mother had other children at home, so she couldn’t stay.

“The preteen was recently diagnosed with cancer and is alone in the hospital, sick, in pain, unable to communicate and undergoing procedures,” she says. “The rule that mom couldn’t come really bothered us nurses, so we asked for special attention to allow her to visit us.”

Appreciation and bgood days to come

Nurses are thanked for their sacrifices by hospital officials, who organize food delivery sponsored by area restaurants, spontaneous staff ceremonies, and fun rewards. But the most meaningful thanks are the words of appreciation from the families and the smiles on the faces of the patients as they walk through the door.

Nurses have more hope about COVID-19 these days. They are comfortable with HIV-positive patients, and the high rate of vaccinations and low rates of infections in California cheer them up.

“We have all been faced with stress during this pandemic,” says Gutierrez. “It helps to focus on the good.”



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