ABSTRACT
The COVID-19 pandemic has caused an unprecedented health crisis. Pressure on the National Health System has created unique demand particularly in certain services and care units like the critical care units. Objective To learn about the experience of nurses in caring for people with coronavirus in critical care units. Method A qualitative phenomenological study that constitutes the second phase of a mixed methodology project. We conducted interviews with 17 nurses caring for patients affected by COVID-19 in critical care units. The interviews were audio-recorded, transcribed, and analysed using thematic discourse analysis. Results This article shows the findings around the theme “the value of human resources” which is nuanced through sub-themes “it's not the beds, it's the expert staff”, “shouldering the patient's burden”, and suffering because “they have not cared well”. Discussion Expert nurses have emerged as leading professionals in the care of the critical patient during the COVID-19 pandemic. This leadership is executed from a profile framed in an inclusive philosophy where wisdom, agility and intuition are the key elements underpinning problem identification and solving in a creative way, while adapting to the needs of the patient and healthcare team as they emerge. Conclusions Expert nurses have played an advanced role in the management of care and human resources by exercising effective leadership in the clinical setting. Care has been hampered due to the crisis, which causes nurses moral distress because they have been unable to meet standards of quality and excellence in care.
ABSTRACT
The COVID-19 pandemic has caused an unprecedented health crisis. Pressure on the National Health System has created unique demand particularly in certain services and care units like the critical care units. OBJECTIVE: To learn about the experience of nurses in caring for people with coronavirus in critical care units. METHOD: A qualitative phenomenological study that constitutes the second phase of a mixed methodology project. We conducted interviews with 17 nurses caring for patients affected by COVID-19 in critical care units. The interviews were audio-recorded, transcribed, and analysed using thematic discourse analysis. RESULTS: This article shows the findings around the theme "the value of human resources" which is nuanced through sub-themes "it's not the beds, it's the expert staff", "shouldering the patient's burden", and suffering because "they have not cared well". DISCUSSION: Expert nurses have emerged as leading professionals in the care of the critical patient during the COVID-19 pandemic. This leadership is executed from a profile framed in an inclusive philosophy where wisdom, agility and intuition are the key elements underpinning problem identification and solving in a creative way, while adapting to the needs of the patient and healthcare team as they emerge. CONCLUSIONS: Expert nurses have played an advanced role in the management of care and human resources by exercising effective leadership in the clinical setting. Care has been hampered due to the crisis, which causes nurses moral distress because they have been unable to meet standards of quality and excellence in care.
Subject(s)
COVID-19 , Critical Care Nursing , Critical Care , Humans , Intensive Care Units , PandemicsABSTRACT
La pandemia por COVID-19 ha supuesto una crisis sanitaria sin precedentes. La presión asistencial sobre el Sistema Nacional de Salud ha generado escenarios insólitos de demanda especialmente llamativos en algunos servicios o unidades asistenciales como las Unidades de Cuidados Críticos. Objetivo Conocer la experiencia de los profesionales enfermeros referida a la atención de personas infectadas por coronavirus en las Unidades de Cuidados Críticos. Método Estudio cualitativo de carácter fenomenológico que constituye la segunda fase de un proyecto de metodología mixta. Se realizaron entrevistas a 17 enfermeras que prestaron cuidados en Unidades de Cuidados Críticos a pacientes afectados de COVID-19. Las entrevistas fueron audiograbadas, transcritas y analizadas mediante análisis temático del discurso. Resultados En este artículo se muestran los hallazgos en torno al tema «el valor del recurso humano» que matiza su significado a través de los subtemas «no son las camas, es el personal experto», «llevando la carga del paciente» y sufriendo por «no haber cuidado bien». Discusión Los profesionales enfermeros expertos se erigen como profesionales líderes en el cuidado del paciente crítico durante la pandemia por COVID-19. Este liderazgo se ejerce desde un perfil enmarcado en una filosofía integradora donde sabiduría, agilidad e intuición son los elementos clave que dan soporte a la identificación y resolución de problemas de forma creativa adaptándose a las necesidades emergentes de los pacientes y equipo de cuidados. Conclusiones Los profesionales enfermeros expertos han desempeñado un rol avanzado en la gestión de cuidados y de recursos humanos mediante el ejercicio de un liderazgo eficiente en el entorno clínico. Los cuidados se han visto mermados por la situación de crisis, circunstancia que les genera sufrimiento moral por no haber podido cumplir con los estándares de calidad y excelencia en el cuidado.
ABSTRACT
The COVID-19 pandemic has caused an unprecedented health crisis. Pressure on the National Health System has created unique demand particularly in certain services and care units like the critical care units. Objective: To learn about the experience of nurses in caring for people with coronavirus in critical care units. Method: A qualitative phenomenological study that constitutes the second phase of a mixed methodology project. We conducted interviews with 17 nurses caring for patients affected by COVID-19 in critical care units. The interviews were audio-recorded, transcribed, and analysed using thematic discourse analysis. Results: This article shows the findings around the theme "the value of human resources" which is nuanced through sub-themes "it's not the beds, it's the expert staff", "shouldering the patient's burden", and suffering because "they have not cared well". Discussion: Expert nurses have emerged as leading professionals in the care of the critical patient during the COVID-19 pandemic. This leadership is executed from a profile framed in an inclusive philosophy where wisdom, agility and intuition are the key elements underpinning problem identification and solving in a creative way, while adapting to the needs of the patient and healthcare team as they emerge. Conclusions: Expert nurses have played an advanced role in the management of care and human resources by exercising effective leadership in the clinical setting. Care has been hampered due to the crisis, which causes nurses moral distress because they have been unable to meet standards of quality and excellence in care.
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of coronavirus disease 2019 (COVID-19). Diabetes is one of the most frequent comorbidities in people with COVID-19 with a prevalence that varies between 7 and 30%. Diabetics infected with SARS-CoV-2 have a higher rate of hospital admission, severe pneumonia, and higher mortality compared to non-diabetic subjects. Chronic hyperglycemia can compromise innate and humoral immunity. Furthermore, diabetes is associated with a low-grade chronic inflammatory state that favors the development of an exaggerated inflammatory response and therefore the appearance of acute respiratory distress syndrome. Recent evidence has shown that SARS-CoV-2 is also capable of causing direct damage to the pancreas that could worsen hyperglycemia and even induce the onset of diabetes in previously non-diabetic subjects. Therapeutic strategies should be aimed at facilitating patient access to the healthcare system. Control of blood glucose and comorbidities must be individualized in order to reduce the incidence of complications and decrease the burden on health systems. In this article we will review the pathophysiological mechanisms that explain the bidirectional relationship between COVID-19 and diabetes mellitus, its implication in the prognosis and management of hyperglycemia in this group of patients.
Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Hyperglycemia/complications , Blood Glucose/metabolism , COVID-19/physiopathology , COVID-19/virology , Diabetes Mellitus/physiopathology , Hospitalization/statistics & numerical data , Humans , Hyperglycemia/physiopathology , Prognosis , SARS-CoV-2/isolation & purificationABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of coronavirus disease 2019 (COVID-19). Acute respiratory distress syndrome is the main cause of death from COVID-19 and occurs due to an exaggerated inflammatory response that causes the release of pro-inflammatory cytokines such as interleukins and tumor necrosis factor-alpha (TNF-α). Statins are lipid lowering drugs with pleiotropic effects. They have shown benefit in the management of inflammatory and autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis. Furthermore, due to their immunomodulatory properties, they have been used in the treatment of various infectious diseases such as community-acquired pneumonia and influenza. In this review we analyze the pathophysiological foundations that support the use of statins as an adjunctive treatment in patients with COVID-19. Resumen El coronavirus tipo 2 del síndrome respiratorio agudo grave (SARS-CoV-2) es el agente causal de la enfermedad por coronavirus 2019 (COVID-19). El síndrome de distress respiratorio agudo constituye la principal causa de muerte por COVID-19 y ocurre por una respuesta inflamatoria exagerada que provoca la liberación de citocinas proinflamatorias como interleucinas y factor de necrosis tumoral alfa (TNF-α). Las estatinas son fármacos hipolipemiantes con efectos pleiotrópicos. Han demostrado beneficio en el manejo de enfermedades inflamatorias y autoinmunes como el lupus eritematoso sistémico, la artritis reumatoide y la esclerosis múltiple. Además, debido a sus propiedades inmunomoduladoras se han utilizado en el tratamiento de diversas enfermedades infecciosas como neumonía adquirida en la comunidad e influenza. En esta revisión analizamos los fundamentos fisiopatológicos que apoyan el uso de estatinas como tratamiento coadyuvante en pacientes con COVID-19.
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of coronavirus disease 2019 (COVID-19). Acute respiratory distress syndrome is the main cause of death from COVID-19 and occurs due to an exaggerated inflammatory response that causes the release of pro-inflammatory cytokines such as interleukins and tumor necrosis factor-alpha (TNF-α). Statins are lipid lowering drugs with pleiotropic effects. They have shown benefit in the management of inflammatory and autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis. Furthermore, due to their immunomodulatory properties, they have been used in the treatment of various infectious diseases such as community-acquired pneumonia and influenza. In this review we analyze the pathophysiological foundations that support the use of statins as an adjunctive treatment in patients with COVID-19.