DIRECTORY OF

OPEN ACCESS

J JOURNALS


P-ISSN: 2548-5962

E-ISSN: 2548-981X

https://ojs.unud.ac.id/index.php/jbn

REVIEW/



Nurse’s Roles in Protecting Cancer Patients During COVID-19 Pandemic

Siluh Nyoman Alit Nuryani1*, Luh Gede Lisnawati2

1Nursing Committee, Sanglah General Hospital.

2Nurse Unit Manager Oncology Ward Sanglah General Hospital.

*Corresponding author: alitnuryani01@gmail.com.

ABSTRACT

Nurses during COVID-19 pandemic outbreak will be front line health care worker providing care for all patient including cancer patients. Cancer patients were vulnerable group that need to be prevented from getting COVID-19. This study will describe the roles of nurses to protect cancer patients during this outbreak. The role of nurses preventing transmission in outpatient including conducting medical distancing to reduce number of patient visit health care. This can be done through screening by phone. Chemotherapy unit, nurses can prevent transmission through physical distancing, providing education and surface cleaning more often than usual in between patient. Oncology ward, nurses need to educate patient family regarding no hospital policy visit. This will reduce number of exposure people to people. The use of PPE wisely due to shortage of resources in may hospital facilities by reducing number of team member entering patient’s room, selectively usage of PPE required for certain nursing procedures, and nurses can perform number of procedures at once whenever nurses enter patients’ room. During this crisis, nurses also need to maintain their mental health by managing their stress and anxiety by balancing between work and rest during shifts, eat sufficient food and healthy, and avoid alcohol and tobacco. Stay connected with friends and family through digital media. Hence, nurses can stay healthy so they care for patients during this pandemic.

Keywords: nurse’s roles, cancer patients, COVID-19, pandemic.

DOI: https://doi.org/10.24843/JBN.2020.v04.is01.p06

INTRODUCTION

Nowadays nurses encounter high pressure during COVID 19 pandemic outbreak. Nurses will be on the front lines providing care to all patient especially cancer patients. In the COVID-19 crisis, cancer patients are regarded as a highly vulnerable group. According to Zhang et al.1 conducted retrospective study among 28 cancer patients with laboratory confirmed COVID-19 from three designated hospitals in Wuhan, China, found that 53.6% of the patients developed severe events, 21.4% were admitted to ICU, 35.7% had life-threatening complications and 28.6% of the patients died. This study also found most infected cancer patients had following symptoms including fever, dry cough, fatigue, dyspnea, blood lymphopenia,

and high levels of hsCRP. Anemia and hyponatremia were also contributing to nutritional problems that lead to immunocompetence and susceptible for respiratory pathogens.1 Therefore, the role of oncology nurses in providing support for cancer patients through number of key strategies.

NURSE’S ROLE PREVENTING OF TRANSMISSION

Cancer patients are visit to hospital for many reasons including consultation, surgery, chemotherapy and radiation. Some oncologists proposed “medical distancing” refer to reducing number of cancer patients who visit health care facilities during COVID-19 outbreak. Cancer centre can

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conduct patient screening by phone before patient visit the clinic this will help to reduce unnecessary visit cancer patients to hospital.2 This can be done by nurse using specific telephone guidelines questions to ask for cancer patients. Oncology nurses can implement this as triage system, so it will benefit for cancer patient reduce their unnecessary visit to hospital. Telehealth or other communication such as WhatsApp is also another way to help cancer patients and cancer survivors for routine symptoms management and non-urgent follow up. Nurses can conduct screening for respiratory illness and referred patients with appropriate specialists before coming to appointment. Open communication with cancer patient will help them to reduce anxiety and confuse from lack of information how to protect them from COVID-19 exposure.3

In outpatient clinic, chemotherapy unit physical distancing mandatory implemented for cancer patient. Those cancer patients must have appointment before come to hospital. Nurse’s roles are providing education to patient and family the importance of physical distancing. Signage, patient handouts both visual are placed at the front and voice sounds announced regularly at outpatient to remind cancer patient for infection prevention including washing hands, using hand sanitizer and water and soap. Nurses also help their working space in outpatients maintained by cleaning and disinfecting surfaces more often than regular basis. Regular household wipes and sprays will kill the virus. And also ensure to clean places that people touch a lot, such as door handles, phones, keyboards, and light switches. This will prevent transmission of virus from staff to cancer patients.

In inpatient oncology, should be prepared to reduce transmission of cancer patients admitted for getting COVID-19. Ueda et al.

(2020) stated that protecting staff through education the use of personal protective equipment (PPE) need to be updated and readily available for staff daily and hourly basis.4 To protect public and patients from exposure and reduce consumptions of PPE, hospital could adopt stringent no hospital visitor policy with rare exceptions such us for end life circumstances. Nurses role are providing education to patient family toward no visitor hospital policy and those family who will stay with patients are also educated for not coming in and out of the hospital. No visitor policy should align with closing hospital entrance and exit door and only staffs are permitted to come to in patient ward. By limiting visitors inpatient ward, it will reduce chance of transmission in the hospitals. This decision is quite difficult therefore the role of security officer at hospital especially in the main gate as gate keeper hospital visitors are crucial implemented.

SHORTAGE OF HEALTH CARE RESOURCES

Corona virus had put pressure for health care resources including availability of isolation room, PPE and hand sanitizer and also availability of nursing staff. Ueda et al.4, oncology nurses are facing challenge to balance between providing life saving for cancer patients and mitigating the risk of getting COVID -19. Resources such us PPE including mask, gloves and gown this is mostly used for chemotherapy are starting to shortage. This is due others also need this equipment. Therefore, providing education for all health care teams to be favouring the use of soap and water for hand washing instead of hand sanitizer, reducing number of team member entering patient’s room, selectively usage of PPE required for certain nursing procedures, and nurses can perform

number of procedures at once whenever nurses enter patients room.4 This strategies not only reduce number of PPE being used also reduce exposure for cancer patient during hospitalization. Blood product shortage also occurred due to decline of blood donor in the community in this outbreak. Therefore, nurses also educate patient prevention from risk of bleeding, and continuing increase their food intake and also quality of their food. Nurse are facing endanger situation if pandemic continue to rise, many cancer patients may increase affected by corona virus. Ueda et al.4 stated that if an oncology patient with late-stage disease or with comorbid health conditions such as heart or lung dysfunction acquires COVID-19 and requires mechanical ventilation, the prognosis is likely to be dismal. Nurses are critical to provide coordination with other health care team what treatment can be successfully, symptoms relieving or life savings and to consider whether patient’s possibility to get the greatest benefit from treatments. Multidisciplinary round discussion can be arranged by nurses to involve palliative care teams, medical ethics, dietitian to assist in treatment plan for cancer patients.

Nursing staff shortage also another issue faces across the world issue if pandemic COVID-19 continues to rise. Jackson et al stated that nursing capacity to provide care at the front line will be affected due to increased workload and many nursing staff was affected by COVID-19. In Australia, government consider various mechanism including fast tracking qualified nurses who recently retired back to work, allowing international qualified nurses who may suitable, establishing temporary register for nurses who left the register within the past three years, also including nursing students to undertake final six months program as

JBN (Jurnal Bedah Nasional) clinical placement.5 In Indonesia health care system, many hospitals open recruitment for many new nurses and government supporting nurses who care for patient in isolation room with additional incentive. The role of nurse educator and administrator to provide adequate learning and resources available to support new nurses that coming into health care workforce. Hence, they could provide safe care for staff and also patients.

MANAGING STRESS AND ANXIETY DURING COVID-19

Stress and anxiety unavoidable affected health care workers during this covid-19 pandemic. World Health Organization (WHO) supporting health care workers through some coping strategies including to balance between work and rest during shifts, eat sufficient food and healthy, and avoid alcohol and tobacco. Stay connected with friends and family especially loves ones that can be done through digital methods.6 Doctor Fatwa Sari Tetra Dewi, MPH., Ph.D., as a Health Promotion Specialist at the Faculty of Medicine, Public Health, and Nursing (FKKMK) UGM, mentioned there were three main steps to deal with stress and anxiety including starting conversation with closest people to share feelings and someone who can help other things to consider is to filter reading and watching the news. Nurses encourage to choose quality reading sources including from CDC, WHO and Ministry of health rather than information that makes them feel increasingly depressed and anxious. Maintain healthy life style by eating nutritious food and balanced food, adequate sleep, maintain physical activities, and exercise.7 Hence many nurses are able to cope and manage their stress and anxiety so that they could provide optimum care for those vulnerable patients during the pandemic outbreak.

CONCLUSION

Nurses are backbone of hospital health care and every nurse has to play role in supporting health including oncology nurses play important role in protecting vulnerable patients including cancer patient during crisis. Strategic roles including providing triage system through patient screening by phone before patient visit the clinic to reduce unnecessary visit cancer patients to hospital. In outpatient clinic, chemotherapy unit physical distancing mandatory implemented for cancer patient. Nurses role are providing education to patient family toward no visitor hospital policy in outpatient and education for the use of rational PPE. Nurses also need to provide coordination with other health care teams to support the best care with available resources. At the end nurses are just a human they also a vulnerable person, during the crisis they need to support from others and managing their own feelings to cope with stress and prevent depression.

DISCLOSURE

Authors declare no conflict of interest of this study.

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