Evaluation of an international health partnership to capacity build emergency, trauma and critical care nurse education and practice in Zambia: An experience from the field.

AIM: To evaluate an international health partnership project to capacity build emergency, trauma and critical care nurse education and practice in Zambia. BACKGROUND: Zambia continues to face a significant workforce challenge and rising burden of communicable and non-communicable diseases, compounded by the COVID-19 pandemic. In response to these, the Zambian Ministry of Health is investing in specialised nurses. Emergency, trauma and critical care nursing education and training were seen as one of the solutions. North-south partnerships have been identified as a force for good to capacity build and develop emerging specialities. SOURCES OF EVIDENCE: We use an evaluative approach, which includes desk research, a rapid literature review and documentary data analysis from published papers, government reports and project documentation. Ethics committee approval was sought and gained in both Zambia and the UK. DISCUSSION: A critical review of the evidence identified three key themes: challenges with changing education and practice, developing Zambian faculty for sustainability and the effect of an international health partnership project on both Zambia and UK. The outcomes from this project are multifaceted; however, the main achievement has been the implementation of emergency, trauma and critical care graduate programmes by the Zambian faculty. CONCLUSION: This experience from the field outlines the benefits and limitations of a north-south partnership and the importance of transparency, shared ownership and collegiate decisions. It has facilitated knowledge exchange and sharing to capacity build emergency, trauma and critical care nursing. IMPLICATIONS FOR NURSING PRACTICE: Lessons learned may be applicable to other international nursing partnerships, these include the need for deep understanding of the context and constraints. Also, the importance of focusing on developing long-term sustainable strategies, based on research, education and practice was noted. IMPLICATIONS FOR NURSING POLICY: This paper outlines the importance of developing nursing education and practice to address the changing burden of disease in line with Zambian national policy, regional and international standards. Also, the value of international nursing partnerships for national and international nursing agendas was described.

Service evaluation of a COVID-19 critical care orientation programme.

BACKGROUND: During the first wave of the COVID-19 pandemic in the UK, south London had the highest number of COVID-19 patients admitted to critical care. At one hospital, staff being redeployed to critical care were invited to attend an orientation to critical care workshop. AIM: To carry out a service evaluation of the training outcomes from rapidly redeployed staff who completed the workshop during the first wave of the COVID-19 pandemic (March-July 2020). METHODS: Two stages were used, the first was a post-workshop evaluation questionnaire completed immediately after the training, with the second involving a single centre e-survey questionnaire two months later. FINDINGS: In total 131 health professionals attended the workshop, and 124 (95%) post-course evaluations were completed. Some 116 staff were contacted for the e-survey, with a response rate of 34% (n=40). Overall, the training was well evaluated. Of the 40 respondents, 70% (n=28) had volunteered, but only just over half (n=21, 52%) went on to work in critical care. CONCLUSION: This article describes the organisational response of one NHS acute hospital to the unprecedented challenges that arose from the COVID-19 pandemic. The service evaluation identified the importance of a pedagogical approach, which not only delivered clinical content, but also allayed anxiety for health professionals preparing to work in a new environment.

The bond and retention of Chinese seafarers for international shipping companies: a survey report

The shortage of junior seafarers in China in recent years raises a salient question as to how international shipping companies can improve retention rates among Chinese crews. This issue has become increasingly prominent in the context of a global lockdown resulting from the Covid-19 pandemic. This paper examines the dilemma through the lens of the “bond” between seafarers and the shipping companies they service, a term used to reflect the need to recognise, consent and integrate into management systems, safety culture, and organizational values. The value of this bond concept is investigated in a survey of Chinese crews ( <italic>N</italic>  = 318). The paper aims to reveal the features and underlying factors of the bond, and its influence on needs, perceptions and seafaring careers in foreign shipping companies. The study finds that the majority of respondents do not have a bond with their shipping company, but typically do wish to develop one. Furthermore, this form of attachment appears to be closely related to career satisfaction and retention. To address the shortage of junior seafarers in China, we call for the development of mutual trust, respect and shared values between global seafarers and international shipping companies. A number of policy recommendations are provided.

COVID-19 disease: Acute Respiratory Distress Syndrome and Prone Position

Patients who develop severe COVID-19 disease can develop respiratory failure and subsequently Acute Respiratory Distress Syndrome (ARDS). However, it has to be noted that these patients may not follow the typical ARDS disease trajectory. The causes of this paradox are complex and not yet fully understood, with the result that varying pathophysiological hypotheses have been proposed. This article describes ARDS in COVID-19 patients and the use of the conscious and unconscious prone position as an intervention to improve oxygenation.

COVID-19 disease: resuscitation

COVID-19 is a complex disease which has challenged the way in which care is provided. Cardiopulmonary resuscitation (CPR) is recognised as a potential aerosol-generating procedure, in consequence, a modified advanced life support approach needs to be followed. This article describes the actions for an adult in cardiac arrest with suspected of confirmed COVID-19 disease in a hospital setting.

COVID-19 Disease: Non-Invasive Ventilation and High Frequency Nasal Oxygenation

Severe COVID-19 causes significant numbers of patients to develop respiratory symptoms that require increasing interventions. Initially, the treatment for severe respiratory failure included early intubation and invasive ventilation, as this was deemed preferable to be more effective than Non-Invasive Ventilation (NIV). However, emerging evidence has shown that NIV may have a more significant and positive role than initially thought. NIV includes Continuous Positive Airway Pressure (CPAP) and Bi-Level Positive Airway Pressure (BiPAP). CPAP is the method of choice with the use of BiPAP for those with complex respiratory conditions who contract COVID-19. The use of High Flow Nasal Oxygen (HFNO) remains contentious with different perspectives in how this modality can be used to treat respiratory failure in COVID-19. Current thinking suggests that NIV and HFNO may be an appropriate bridging adjunct in the early part of the disease progress and may prevent the need for intubation or invasive ventilation. Patients requiring NIV or HFNO may be nursed in locations outside of the critical care unit. Therefore, this article reviews the different types of NIV and HFNO, indications and the nursing care.

COVID-19 Disease: assessment of a critically ill patient

With the major scale up of critical care services to respond to the increasing numbers of patients with severe COVID-19 infection, nurses need to be able to rapidly assess patients. While many patients present with signs of viral pneumonia and may develop respiratory failure, it is essential that the subsequent systemic complications are also recognized. Due to the unprecedented numbers of patients requiring critical care, many of them will initially have to be managed in the emergency departments and acute wards until a critical care bed becomes available. In this article, the assessment of a patient with suspected or confirmed severe COVID-19 has been presented initially from a ward perspective, followed by that of critical care, using the Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach. This article has been specifically designed to enable nurses to systematically assess patients and prioritise care.

COVID-19 Disease: invasive ventilation

This article focuses on the critical care nurse’s role in the management of patients with COVID-19 who require invasive ventilation in order to improve outcomes and prevent complications. The nature of COVID-19 is such that many patients deteriorate rapidly and for members of this group requiring intubation and invasive ventilation, different approaches to airway management and ventilatory support are required. In order to reduce the risk of complications and an overview of invasive ventilation, including commonly used modes, potential complications, nursing care, weaning and extubation are all described. COVID-19 presents several challenges as the disease progresses, hypoxemia may worsen, and the patient can develop Acute Respiratory Distress Syndrome. Therefore, additional treatment strategies including the use of the prone position and the use of nitric oxide and prostacyclin nebulisers have been included. The strategies presented in this article are relevant to both critical care nurses and those re-deployed to intensive care units where nurses will inevitably be involved in the management of patients requiring invasive ventilation. Weaning these patients off invasive ventilation is multi-factorial and may be short or long term. A multi-disciplinary weaning plan, the principles, stages/phases, and speed of weaning with expected parameters prior extubation are explained. Planned and unplanned extubation with the serious complications of the latter as the patient may not be ready and may require emergency re-intubation resulting in setbacks should be avoided.

COVID-19 Disease: Perspectives in Low- and Middle-Income Countries

Pandemics such as COVID-19 bring significant challenges for all health services, especially those in low-to low-middle income countries, where access to supplement and expand services may be difficult. For these countries with a limited workforce the loss of key workers to the illness itself or the need to self-isolate following contact can paralyse service delivery. This article looks at some of the issues that may arise and strategies to overcome them. It includes a case study from Viet Nam illustrating the need for a rapid integrated response to contact and prevent further outbreaks. Caring for COVID-19 patients is a heavily dependent on the skills and expertise of the nurses. There is therefore a need to share nursing interventions that can be implemented without major resource implications in all hospital departments.

COVID-19 disease: a critical care perspective

COVID-19 is a new highly infectious disease with an incompletely described clinical course, which has caused a pandemic, with Europe being identified as the third epicentre. COVID-19 has placed unprecedented pressure on critical care services which is likely to stretch resources beyond capacity. The situation is exacerbated by increased staff absence from self-isolation and illness, increased referral of patients with suspected or confirmed COVID-19 who develop respiratory failure, and limited availability of Extra Corporeal Membrane Oxygenation (ECMO) services. In addition, there is the ongoing challenge of patients being transferred between departments and hospitals for ongoing care. In consequence, as current needs continue to rise, innovative approaches are needed to redress shortages and support the continuance of services. This article provides an overview of severe COVID-19 infection, outlining treatment strategies and nursing processes that will need to develop and extend in response to this evolving situation.