Ma. Rita Villanueva-Tamse teaches in the UP Open University (UPOU) Master of Arts in Nursing (MAN) program and at the UP Manila College of Nursing, where she earned her bachelor’s and master’s degrees. She is a former chief of the UP Philippine General Hospital (UP-PGH) Division of Clinical Nursing Operations and a former deputy director for Nursing at the same hospital. She has almost 40 years of experience in nursing administration.
She was one of three nurses who shared their COVID-19 experiences in “Who Takes Care of the Caregivers?”, an episode of UPOU’s Let’s Talk it Over online lecture series that was streamed live on June 11 on UPOU Networks. It was organized by the MAN program of the UPOU Faculty of Management and Development Studies.
So, what do nurses need from their leaders?
That visibility and availability rank high up in that list is what Tamse revealed. They need to show their nurses that they are readily available to listen to concerns and give assistance. Establishing an open line of communication is crucial to letting frontline workers know they are valued and cared for by their institutions. Health care organizations being attuned to their needs, through consultation and participation allows these organizations to create operational strategies during a crisis that strike a balance between providing service and making sure their workers are not overwhelmed.
Tamse explained how, for example, during a pandemic, responding to a disruption in regular health care services entails: looking at the necessary resources; innovative task shifting; restructuring services; making appropriate and rational staff assignments; and, surge planning. Decision-making must be fluid to adapt to a crisis. Knowing the physical, emotional, and mental health needs of their workers, professionally and personally,ensures that health services are delivered in the best way possible.
She said how ironic it is that while 2020 marks the International Year of the Nurse and the Midwife, this year has also become very challenging for nurses because of COVID-19. Nurses, who already play a critical role in the healthcare system, have seen the magnification and increased gravity of their contribution to the management of a highly infectious new disease. As they tend to COVID-19 patients, they are in a position to orchestrate coordination for interdisciplinary care and are the first to deal with patient safety and mitigation of complications.
Tamse said that it is the responsibility of nursing administrators and institutions to manage the knowledge and skills gap. She said, “Not all nurses are infectious care nurses.” In a crisis where it is all hands on deck, it is necessary to arm nurses with the proper knowledge and skills to allow them to perform their new tasks better. This requires not only training but “mix-matching” non-infectious care nurses with infectious care nurses who serve as mentors to the former. She emphasized how all health care workers, including utility personnel, should be considered in a well-crafted response to a crisis.
The engagement of hospital employees in successfully managing COVID-19 should be encouraged by the institution through its leaders. Timely and consistent information is shared. Conflicts are managed efficiently. Workers are empowered to innovate and be creative. Support is clearly given with a positive attitude. Milestones should be celebrated and service is given meaningful recognition.
Policy directions resulting from the COVID-19 crisis should “synthesize experience to come up with evidence-based practice”. Tamse added that principles on pandemic response must be harmonized, including human resource management. Protocols must be fine-tuned through research. Relevant agencies must collaborate to draft a pandemic preparedness and response plan that is appropriate and sensitive. All this are needed so as to create a Philippine-specific system of managing pandemics.
Tamse, whose graduate degree focused on mental health and psychiatric nursing, addressed nurses by giving them the following advice: eat well and get enough sleep and rest; acknowledge, verbalize and share feelings of anxiety; and, be positive by using positive language.
On patient care, she said that nurses should provide a calming presence because “the most frightening thing [for patients] in this pandemic is being alone . . . . If we are fearful, our patients are doubly fearful. If we are anxious, they are more seriously anxious.” She added that the tone of voice and choice of words were key to reassure patients that they are receiving the best care possible in this situation. By giving accurate information, nurses can also ease uncertainties felt by their patients. And if nurses and the hospitals themselves can find ways to enable their patients to virtually connect with their families, then it will make their patients feel more supported in their fight against COVID-19.
Tamse, talking to nursing administrators this time, underscored the need to prioritize the prevention of burnout in nurses by providing psychosocial support mechanisms on top of physical well-being considerations. Some of the ways by which this can be accomplished include providing opportunities for communication through briefing and debriefing before and after shifts, or during their donning and doffing of personal protective equipment. Mandatory breaks should also be observed. A buddy or mentoring system can be put in place as a support strategy. “[Also], don’t prevent our nurses from expressing how they feel . . . . Encourage hopefulness, learning, flexibility, and adaptability.”
In the workplace, caring for these caregivers ultimately rests upon the nurses themselves, their peers and colleagues, their nursing leaders, and the administrators of their institution.