Florence Nightingale, the torchbearer of modern nursing, who heralded a new era in healthcare during the Crimean War, is known to have said that it would take another 150 years before the world could see standards in nursing that she was envisioning. In 2020, at a time when the whole world, is struggling to combat the COVID-19 pandemic, nurses are at the frontline to save lives, while risking their own. As heartbreaking images and stories of rising infections and mortalities flood the news headlines every morning, nurses more than ever, not only need the safety equipment and standards, but also the emotional support that they so much deserve for their services in the most trying times of humanity.
As COVID-19 strikes countries and people across the globe, regardless of their economic status, news stories are widespread of healthcare workers who were left without enough protective kits. The world has come a long way from Nightingale using polar pie to register the cause of mortality to 21st-century digital platforms to track infections and mortality. However, in the face of a global pandemic, the most developed countries seem to be not only underprepared to arrest the growing virus outbreak, but also to keep safe those, who are saving lives, by risking their own lives.
The short supply of Personal Protective Equipment (PPE) for nurses and others working in the highly vulnerable zones have been widely reported. Nurses resorting to makeshift means to protect themselves is a testament to how underprepared we are in the times of a public health crisis. Not only the availability of PPE but also its optimum effect on protection can only be realized with the use of the right kind of PPE and worn in the right way. For doctors and nurses, patients are a priority and not themselves. Amidst the chaos of a soaring number of cases, healthcare professionals lack clarity at times because of the indecisiveness about testing, PPE availability, quarantine stay, facility crisis, and health care professionals themselves becoming sick.
The goals of global health cannot reach its target unless nurses’ workforce is standardized in its practice and policies. The World Health Organization (WHO), the specialized agency of the United Nations on global health, which has been at the forefront of combating the COVID-19 outbreak, has clearly recommended the use of PPE, for healthcare workers. Even developed countries have been struggling to meet the short supply of protective kits by themselves or by cooperation and coordination with other countries, and a number of means are being devised to make them available for those working in healthcare. For instance, in India, normal citizens, have been encouraged to use a simple homemade protective mask, so that professional masks can be left available for the use of healthcare workers. Local handmade masks are already in place in Indian villages where community Nursing officers sew and distribute masks to the mass for mitigating COVID 19 transmission.
In today’s healthcare scenario, administrators take major decisions regarding patient-care, healthcare equipment, and material management and not health care professionals. When doctors and nurses cry aloud and say, “Provide PPE”, it literally means, that they need to be safe too while saving lives. Sadly, we have lost doctors, nurses, and other health care professionals who fought valiantly and gave their lives while saving the lives of fellow human beings. But, did we hear their calls for safety?
Moreover, every now and then, despite calls for showing respect to healthcare workers risking their own lives at the time of the pandemic, a number of stories have come up, where they have faced harassment at the hands of the normal public. If this is going to be the real treatment that they endure, no amount of hand-clapping, banging on utensils or lighting lamps would make amends. Prime Minister Narendra Modi has enforced a new law to tackle harassment and attacks on health care workers by emphasizing on strict punishment for those attacking frontliners at the time of the COVID-19 pandemic. It may be too early to evaluate, but policies and standard operating systems across the professional bodies and organizations have a greater role to play if the Epidemic Diseases (Amendment) Ordinance, 2020 announced by PM Modi is to be properly realized.
This unique experience of pandemic gives us a clearer vision that we look forward to public health maintenance. Strengthening public health through an interprofessional approach to learning seems to be the future. This means that the graduates learn and practice together to reduce chaos and bring about positive outcomes on health care. Interprofessional collaboration and practice are required for safe care and trying to build a thinner wall between professions to build a healthy healthcare scenario that would avoid repetition, role confusion, misunderstanding, errors but bring quality-unified care. Technically, this should translate to every graduate in Medical, Nursing, Allied and any technical field that has an impact on health outcomes should work with guiding protocols and framework to take care of primary health care in India. India needs primary care and graduates functioning in rural health centers as medical officers and nursing officers assessing, diagnosing, and treating minor ailments is the future of sustenance.
The goals of the WHO, as the apex body handling global pandemic, reflects a few of these endeavors. The WHO looks at raising the status of nurses and their profiles, as the world needs 9 million more nurses to achieve the universal health coverage global by 2030. Dr. Tedros Adhanom Ghebreyesus, the Director-General of the WHO has rightly stated, “Without nurses and midwives, we will not achieve sustainable development goals or universal health coverage.” Annette Kennedy, President, International Council for Nurses invokes, “The 20 million nurses around the world will be thrilled to see their recognition in this way.” This statement is heartwarming for the enormous contributions nurses have made across the world, in normal times, and more evidently, during the times of crisis. This statement should be a clarion call for countries, across the world, to think and implement the ways and means to realize the role of nurses in achieving national and global health goals.
Nigel Crisp, Co-chair, Nursing Now says, “Investing in nursing and midwifery will make an enormous contribution to the rapid, cost-effective and high quality scaling up of universal health care.” Today, nurses are involved in idea-creation and prototyping various health care challenges and innovations, yet patenting and its progress are dwindling. Nurses are also conducting cutting-edge researches besides their clinical duties. On the first of April 2020, the International Council for Nurses conveyed, saying that the 200th anniversary of Florence Nightingale is more relevant given the mass contribution nurses have put forth toward COVID-19 forefront management across the globe. The COVID-19 pandemic has put the work of nurses in sharp focus ahead our International Nurses’ Day leading to the global nursing body united by challenges posed. This moment should be used, to realize the call for effective nursing leadership, working conditions, and safety. Nursing needs to improve global health in the days to come. Therefore, the goal of health for all lies in crystalizing and bringing about health care professionals working together in harmony with standards of practice in place to provide quality care in normal and pandemic times.
About the Experts:
Dr. Elsa Sanatombi Devi is a FAIMER Fellow, Professor & QMR at Manipal College of Nursing (MCON), Manipal Academy of Higher Education (MAHE), Manipal and faculty at FAIMER International institute, MAHE, Manipal. She coordinates the first IELTS center in India in collaboration with NHS, UK. She is also a fellow observer under the USIEF grant for 21 st century initiatives to MGH Boston, USA. She is the recipient of UWS- GCRF fund to develop family and community capacity to provide evidence-informed advanced dementia care and reduce risks of dementia-related elder abandonment and abuse in India. She was the recipient of the President’s gold medalist for the best outgoing student in M.Sc. Nursing.
Dr. Ciraj Ali Mohammed is the Director of FAIMER International Institute, Manipal Academy of Higher Education (MAHE), Manipal, and Deputy Director of the Centre for Continuing Education and Interprofessional, Development (CCEID), and Professor of Microbiology. He holds a distinct position of global faculty of the FAIMER Institute, Philadelphia, and is a recipient of the American Society for Microbiology, Honorable Mention award (2010), UNESCO award for International Educators (2011) and Outstanding Mentor award (2012). He was a Fulbright visiting scholar at the Department of Molecular Biology and Infectious Diseases, Florida International University, Miami. He is the Chair of IndiPEN and is the Secretary of the Indian Academy of Health Professions Education.
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